Provider Demographics
NPI:1811742117
Name:GILLMAN, CAITLIN (CASAC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:GILLMAN
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 MADISON AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3809
Mailing Address - Country:US
Mailing Address - Phone:518-330-0077
Mailing Address - Fax:518-314-9962
Practice Address - Street 1:747 MADISON AVE STE 303
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3809
Practice Address - Country:US
Practice Address - Phone:518-330-0077
Practice Address - Fax:518-314-9962
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY36835101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator