Provider Demographics
NPI:1821356569
Name:NORTH, CAITLIN RUDDY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:RUDDY
Last Name:NORTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 VONDERBURG DR
Mailing Address - Street 2:#301
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5954
Mailing Address - Country:US
Mailing Address - Phone:844-450-7629
Mailing Address - Fax:
Practice Address - Street 1:2960 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-1952
Practice Address - Country:US
Practice Address - Phone:727-543-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 12028101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)