Provider Demographics
NPI:1417640376
Name:VISCO-FORDE, CAITLIN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:VISCO-FORDE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 RIVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-2147
Mailing Address - Country:US
Mailing Address - Phone:908-397-0004
Mailing Address - Fax:
Practice Address - Street 1:433 RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-2147
Practice Address - Country:US
Practice Address - Phone:908-397-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061996001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical