Provider Demographics
NPI:1720733934
Name:ANDERSON, CAITLIN MACY (LPC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MACY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 PINE ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6595
Mailing Address - Country:US
Mailing Address - Phone:915-204-1411
Mailing Address - Fax:
Practice Address - Street 1:2101 PINE ST APT 1B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6595
Practice Address - Country:US
Practice Address - Phone:915-204-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional