Healthcare Provider Details

I. General information

NPI: 1710328349
Provider Name (Legal Business Name): CAITLIN FILLMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BAY VIEW DR
MOUNTAIN VIEW CA
94043-2243
US

IV. Provider business mailing address

3490 THE ALAMEDA
SANTA CLARA CA
95050-4333
US

V. Phone/Fax

Practice location:
  • Phone: 415-291-0480
  • Fax:
Mailing address:
  • Phone: 408-243-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: