Provider Demographics
NPI:1407233935
Name:GRZYBEK, CAITLYN DANIELLE (LCSWC)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:DANIELLE
Last Name:GRZYBEK
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:DANIELLE
Other - Last Name:DSTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2336 GODDARD PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1126
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:29520 CANVASBACK DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7124
Practice Address - Country:US
Practice Address - Phone:410-822-5007
Practice Address - Fax:410-822-5569
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLM49EAOtherCAREFIRST BCBS LOCAL
MD259147-000OtherMAGELLAN HEALTH CARE
MD346646OtherMHN/TRICARE
MD609550002Medicaid
MD522156095OtherCOMMERCIAL INSURANCE
MDR968OtherCAREFIRST BCBS BLUES
MD7840093OtherAETNA
MD742LMedicare PIN