Provider Demographics
NPI:1255990578
Name:SOUCY, CAITLIN PATRICIA
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:PATRICIA
Last Name:SOUCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 OLD MEADOW PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9771
Mailing Address - Country:US
Mailing Address - Phone:860-371-5711
Mailing Address - Fax:
Practice Address - Street 1:47 JOLLEY DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3092
Practice Address - Country:US
Practice Address - Phone:860-243-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004764363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical