Provider Demographics
NPI:1265114409
Name:POLO, CAITLIN R
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:R
Last Name:POLO
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 1:42 RENA MARIE CIR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1906
Mailing Address - Country:US
Mailing Address - Phone:845-699-7677
Mailing Address - Fax:
Practice Address - Street 1:42 RENA MARIE CIR
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1906
Practice Address - Country:US
Practice Address - Phone:845-699-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health