Provider Demographics
NPI:1982124400
Name:HARVEY, CAITLIN DIANE (BCBA)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:DIANE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:CAITLIN
Other - Middle Name:D
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:31 PINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6807
Mailing Address - Country:US
Mailing Address - Phone:912-677-4292
Mailing Address - Fax:
Practice Address - Street 1:4 OLIVER CT STE 105
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:912-677-4292
Practice Address - Fax:912-200-5712
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-18-30686103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst