Provider Demographics
NPI:1134966740
Name:AMOS, CAITLIN (MHC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:AMOS
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58-84 NORFOLK ST UNIT 429
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-5812
Mailing Address - Country:US
Mailing Address - Phone:434-251-6228
Mailing Address - Fax:
Practice Address - Street 1:459 COLUMBUS AVE STE 1023
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5129
Practice Address - Country:US
Practice Address - Phone:434-251-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health