Provider Demographics
NPI:1902552607
Name:FORTSON, CAITLYNN M (BSW, LSW)
Entity Type:Individual
Prefix:
First Name:CAITLYNN
Middle Name:M
Last Name:FORTSON
Suffix:
Gender:F
Credentials:BSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 RACE ST STE 302
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-7366
Mailing Address - Country:US
Mailing Address - Phone:513-381-1531
Mailing Address - Fax:
Practice Address - Street 1:9482 WEDGEWOOD BLVD STE 50
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-0268
Practice Address - Country:US
Practice Address - Phone:614-347-3982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.13022868104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker