Provider Demographics
NPI:1639512387
Name:WALSH, CAITLIN (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 HUNTINGTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5970
Mailing Address - Country:US
Mailing Address - Phone:650-877-8642
Mailing Address - Fax:650-877-8643
Practice Address - Street 1:1486 HUNTINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5970
Practice Address - Country:US
Practice Address - Phone:650-877-8642
Practice Address - Fax:650-877-8643
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72675106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist