Provider Demographics
NPI:1629699830
Name:WEESE, CAITLIN (MA, LMSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:WEESE
Suffix:
Gender:F
Credentials:MA, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9039 CHESLEY KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-1645
Mailing Address - Country:US
Mailing Address - Phone:410-507-3603
Mailing Address - Fax:
Practice Address - Street 1:839G QUINCE ORCHARD BLVD STE G
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1603
Practice Address - Country:US
Practice Address - Phone:410-507-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24861104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker