Provider Demographics
NPI:1912454562
Name:SOUTHWOOD, CAIT
Entity Type:Individual
Prefix:
First Name:CAIT
Middle Name:
Last Name:SOUTHWOOD
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 1:181 WINSLOW ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-3056
Mailing Address - Country:US
Mailing Address - Phone:781-296-9370
Mailing Address - Fax:
Practice Address - Street 1:181 WINSLOW STREET
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050
Practice Address - Country:US
Practice Address - Phone:781-206-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS59991821103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst