Provider Demographics
NPI:1932641495
Name:CAITLIN ROSE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:CAITLIN ROSE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-215-1324
Mailing Address - Street 1:702 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2123
Mailing Address - Country:US
Mailing Address - Phone:203-215-1324
Mailing Address - Fax:
Practice Address - Street 1:702 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2123
Practice Address - Country:US
Practice Address - Phone:203-215-1324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty