Healthcare Provider Details

I. General information

NPI: 1083574339
Provider Name (Legal Business Name): CAITLIN JULIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W QUEEN ST
SOUTHINGTON CT
06489-1032
US

IV. Provider business mailing address

1579 HAMILTON AVE APT C10
WATERBURY CT
06706-2419
US

V. Phone/Fax

Practice location:
  • Phone: 860-863-5663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2397
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: