Provider Demographics
NPI:1801578711
Name:ELY, CAITLIN A (LMSW)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:A
Last Name:ELY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2504
Mailing Address - Country:US
Mailing Address - Phone:315-782-9450
Mailing Address - Fax:315-782-2643
Practice Address - Street 1:1220 COFFEEN ST BLDG 17
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1822
Practice Address - Country:US
Practice Address - Phone:315-786-1042
Practice Address - Fax:315-786-7162
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-P122497-01104100000X
NY121284104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker