Healthcare Provider Details

I. General information

NPI: 1639694631
Provider Name (Legal Business Name): CAITLIN CARR LICSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN CARR LICSW, MSW

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 LILLIE LN SE
PINE ISLAND MN
55963-6782
US

IV. Provider business mailing address

7 LILLIE LN SE
PINE ISLAND MN
55963-6782
US

V. Phone/Fax

Practice location:
  • Phone: 952-457-0542
  • Fax:
Mailing address:
  • Phone: 952-457-0542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23738
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: