Provider Demographics
NPI:1760018279
Name:CLARK, CAITLIN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 CRANESBILL CT APT 302
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-2422
Mailing Address - Country:US
Mailing Address - Phone:410-776-5142
Mailing Address - Fax:
Practice Address - Street 1:4C NORTH AVE STE 423
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2334
Practice Address - Country:US
Practice Address - Phone:410-370-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24787104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker