Provider Demographics
NPI:1619411105
Name:LEAGUE, CAITLIN (BASW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:LEAGUE
Suffix:
Gender:F
Credentials:BASW
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BASW
Mailing Address - Street 1:64 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3701
Mailing Address - Country:US
Mailing Address - Phone:603-357-4400
Mailing Address - Fax:603-357-9648
Practice Address - Street 1:24 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3744
Practice Address - Country:US
Practice Address - Phone:603-357-4400
Practice Address - Fax:603-357-9648
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist