Healthcare Provider Details

I. General information

NPI: 1225404767
Provider Name (Legal Business Name): CAITLIN IRENE TALBOT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAITLIN IRENE MCDERMOTT MSW

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 W BLAINE ST
RIVERSIDE CA
92507-3970
US

IV. Provider business mailing address

31566 RAILROAD CANYON RD STE 2 PMB 704
CANYON LAKE CA
92587
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: