Provider Demographics
NPI:1740521038
Name:STEVENS, CAITLIN ETAIN (LCSW-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ETAIN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W EMMA AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2531
Mailing Address - Country:US
Mailing Address - Phone:301-641-0729
Mailing Address - Fax:
Practice Address - Street 1:915 W EMMA AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2531
Practice Address - Country:US
Practice Address - Phone:301-641-0729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD151231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical