Provider Demographics
NPI:1689072514
Name:LABRADOR, CAITLIN ROSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:ROSE
Last Name:LABRADOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:CAITLIN
Other - Middle Name:ROSE
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, RCSWI
Mailing Address - Street 1:1301 PLANTATION ISLAND DR S STE 201B
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3116
Mailing Address - Country:US
Mailing Address - Phone:904-342-5965
Mailing Address - Fax:
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 201B
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3116
Practice Address - Country:US
Practice Address - Phone:904-342-5965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW139161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029591400Medicaid