Provider Demographics
NPI:1669986931
Name:O'SULLIVAN, CAITLIN MARIE (SUDP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARIE
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 WETMORE AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2927
Mailing Address - Country:US
Mailing Address - Phone:425-595-6773
Mailing Address - Fax:425-258-5275
Practice Address - Street 1:2610 WETMORE AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2927
Practice Address - Country:US
Practice Address - Phone:425-258-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60710266101YA0400X
WACP61226345101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty