Healthcare Provider Details

I. General information

NPI: 1740905231
Provider Name (Legal Business Name): CAITLYN KEIB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLYN KRANICH

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN ST
DURHAM CT
06422-1653
US

IV. Provider business mailing address

118 RIDGETOP RD
WALLINGFORD CT
06492-2051
US

V. Phone/Fax

Practice location:
  • Phone: 860-245-9899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009669
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: