Provider Demographics
NPI:1619429743
Name:MAGIDSON, CAITLIN (LGPC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:MAGIDSON
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 MONTROSE AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4108
Mailing Address - Country:US
Mailing Address - Phone:240-620-6686
Mailing Address - Fax:
Practice Address - Street 1:7979 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2429
Practice Address - Country:US
Practice Address - Phone:224-801-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health