Provider Demographics
NPI:1831698687
Name:TODD, CAROLINE JOAN (MFT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:JOAN
Last Name:TODD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 GRANT ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2940
Mailing Address - Country:US
Mailing Address - Phone:415-860-5109
Mailing Address - Fax:
Practice Address - Street 1:1060 GRANT ST STE 1A
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2940
Practice Address - Country:US
Practice Address - Phone:415-860-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist