Healthcare Provider Details

I. General information

NPI: 1891350120
Provider Name (Legal Business Name): CAITLIN MELISSA CICHOLSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 N ILLINOIS ST STE 350
CARMEL IN
46032-3009
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-5073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34008449A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: