Provider Demographics
NPI:1841571536
Name:LEITNER-FLYNN, CAITLIN BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:BETH
Last Name:LEITNER-FLYNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:BETH
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:93 MOUNTAIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823-2542
Mailing Address - Country:US
Mailing Address - Phone:908-399-5042
Mailing Address - Fax:
Practice Address - Street 1:445 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2695
Practice Address - Country:US
Practice Address - Phone:908-399-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05563300101YM0800X
NJ47-3221505101YM0800X
NJ44SL05713800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05563300OtherLCSW
NJ44SL05713800OtherSOCIAL WORK EXAMINERS - LICENSED SOCIAL WORKER