Healthcare Provider Details

I. General information

NPI: 1972383503
Provider Name (Legal Business Name): CAITLYN SPUCKES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 ROUTE 17 N, SUITE 1181
MAYWOOD NJ
07607
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD, BLDG 2, STE 220
RED BANK NJ
07701-5688
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-4450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06641300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: