Healthcare Provider Details

I. General information

NPI: 1811034416
Provider Name (Legal Business Name): CAITLIN PAIGE FLOM MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3468 MT DIABLO BLVD STE. A200
LAFAYETTE CA
94549-3957
US

IV. Provider business mailing address

3468 MT DIABLO BLVD STE. B301
LAFAYETTE CA
94549-3957
US

V. Phone/Fax

Practice location:
  • Phone: 510-325-0574
  • Fax:
Mailing address:
  • Phone: 510-325-0574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: