Provider Demographics
NPI:1639512387
Name:WALSH, CAITLIN (PPS SC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:PPS SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W DANA ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94041-1406
Mailing Address - Country:US
Mailing Address - Phone:650-526-3520
Mailing Address - Fax:650-526-3520
Practice Address - Street 1:115 W DANA ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-1406
Practice Address - Country:US
Practice Address - Phone:650-526-3520
Practice Address - Fax:650-526-3520
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72675106H00000X
CA210244295101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist