Provider Demographics
NPI:1518205533
Name:SIMMONS, CAITLIN MARIE (BS)
Entity Type:Individual
Prefix:MISS
First Name:CAITLIN
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 TRISH DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-1945
Mailing Address - Country:US
Mailing Address - Phone:415-328-9479
Mailing Address - Fax:
Practice Address - Street 1:60 TRISH DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-1945
Practice Address - Country:US
Practice Address - Phone:415-328-9479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health