Provider Demographics
NPI:1679946826
Name:BENNETT, CAITLIN (ASW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0950
Mailing Address - Country:US
Mailing Address - Phone:530-529-9454
Mailing Address - Fax:
Practice Address - Street 1:490 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3019
Practice Address - Country:US
Practice Address - Phone:530-841-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW688121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical