Provider Demographics
NPI:1518058585
Name:CAULIN, MICHAEL D (MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:CAULIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 US RTE 4E
Mailing Address - Street 2:STE 2A
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05201
Mailing Address - Country:US
Mailing Address - Phone:802-775-6331
Mailing Address - Fax:802-775-6373
Practice Address - Street 1:1085 US RTE 4E
Practice Address - Street 2:STE 2A
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05201
Practice Address - Country:US
Practice Address - Phone:802-775-6331
Practice Address - Fax:802-775-6373
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT225103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
990237OtherMVP
094097OtherVALUE OPTIONS
FORE08028174OtherBCBS
VT1006695Medicaid
FORE08028175OtherBCBS