Provider Demographics
NPI:1508307240
Name:MCARDLE, CAITLIN SARA (LICSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SARA
Last Name:MCARDLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 TALINE CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1653
Mailing Address - Country:US
Mailing Address - Phone:910-420-0866
Mailing Address - Fax:857-314-6761
Practice Address - Street 1:8925 TALINE CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1653
Practice Address - Country:US
Practice Address - Phone:910-420-0866
Practice Address - Fax:857-314-6761
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000224927104100000X
NY099110104100000X
RICSW019971041C0700X
MA0001238661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI410005OtherPTAN
RI1871918870Medicare NSC
RI61337Medicare PIN