Healthcare Provider Details

I. General information

NPI: 1093532566
Provider Name (Legal Business Name): CAITLIN MACKECHNIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 WEBBS LN
DOVER DE
19904-5438
US

IV. Provider business mailing address

901 N MARKET ST APT 504
WILMINGTON DE
19801-3088
US

V. Phone/Fax

Practice location:
  • Phone: 602-696-7439
  • Fax:
Mailing address:
  • Phone: 602-696-7439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number265920
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: