Healthcare Provider Details

I. General information

NPI: 1003731597
Provider Name (Legal Business Name): CAITLIN DERMODY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 WHITING AVE
DEDHAM MA
02026-3046
US

IV. Provider business mailing address

791 SOUTH ST UNIT 6
WRENTHAM MA
02093-1517
US

V. Phone/Fax

Practice location:
  • Phone: 781-915-4457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP96249
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: