Provider Demographics
NPI:1033605241
Name:MASTROMARINO, CAITLYN (LCMHC)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:MASTROMARINO
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TSIENNETO RD UNIT 85
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1552
Mailing Address - Country:US
Mailing Address - Phone:508-736-0061
Mailing Address - Fax:603-883-1568
Practice Address - Street 1:124 HALL ST STE J3
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3478
Practice Address - Country:US
Practice Address - Phone:508-556-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health