Healthcare Provider Details

I. General information

NPI: 1649187972
Provider Name (Legal Business Name): CAITLIN JEWEL MACDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E HUNTINGTON DR
MONROVIA CA
91016-6419
US

IV. Provider business mailing address

2723 KENDALL ST
LA VERNE CA
91750-3717
US

V. Phone/Fax

Practice location:
  • Phone: 626-471-2000
  • Fax:
Mailing address:
  • Phone: 626-374-2251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: