Provider Demographics
NPI:1649893462
Name:SCHUPBACH, CAILIN MARIE (LICSW, SUDP)
Entity type:Individual
Prefix:
First Name:CAILIN
Middle Name:MARIE
Last Name:SCHUPBACH
Suffix:
Gender:
Credentials:LICSW, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 N 173RD ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5458
Mailing Address - Country:US
Mailing Address - Phone:716-982-5450
Mailing Address - Fax:
Practice Address - Street 1:1116 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2831
Practice Address - Country:US
Practice Address - Phone:253-886-3897
Practice Address - Fax:206-542-0326
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW61495395104100000X
NY107116104100000X
WACP61159713101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker