Provider Demographics
NPI:1841955994
Name:CUBBERLY, CAITLYN LAUREN (LLMSW)
Entity type:Individual
Prefix:MISS
First Name:CAITLYN
Middle Name:LAUREN
Last Name:CUBBERLY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 S SHORE DR STE 214
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5446
Mailing Address - Country:US
Mailing Address - Phone:269-282-4685
Mailing Address - Fax:
Practice Address - Street 1:391 S SHORE DR STE 214
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5446
Practice Address - Country:US
Practice Address - Phone:269-964-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011069661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical