Provider Demographics
NPI:1720367162
Name:CAFFERTY, JAMES MICHAEL (LMFT, CATC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:CAFFERTY
Suffix:
Gender:M
Credentials:LMFT, CATC
Other - Prefix:
Other - First Name:KANSAS
Other - Middle Name:
Other - Last Name:CAFFERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, CATC
Mailing Address - Street 1:543 ENCINITAS BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3744
Mailing Address - Country:US
Mailing Address - Phone:760-583-3837
Mailing Address - Fax:
Practice Address - Street 1:543 ENCINITAS BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3744
Practice Address - Country:US
Practice Address - Phone:760-517-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51709106H00000X
CAC0505091431101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)