Healthcare Provider Details

I. General information

NPI: 1841571536
Provider Name (Legal Business Name): CAITLIN BETH LEITNER-FLYNN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN BETH FLYNN LCSW

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 MARSHALL ST
PHILLIPSBURG NJ
08865-2695
US

IV. Provider business mailing address

93 MOUNTAIN LAKE RD
BELVIDERE NJ
07823-2542
US

V. Phone/Fax

Practice location:
  • Phone: 908-399-5042
  • Fax:
Mailing address:
  • Phone: 908-399-5042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC05563300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number47-3221505
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05713800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: