Provider Demographics
NPI:1750721577
Name:SEVERIN, CAITLIN ROSA-HAWLEY
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:ROSA-HAWLEY
Last Name:SEVERIN
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 1:50 CRESTA DR
Mailing Address - Street 2:#14
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-5554
Mailing Address - Country:US
Mailing Address - Phone:415-846-9636
Mailing Address - Fax:
Practice Address - Street 1:50 CRESTA DR
Practice Address - Street 2:#14
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-5554
Practice Address - Country:US
Practice Address - Phone:415-846-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87412106H00000X
CAIMF75531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist