Healthcare Provider Details

I. General information

NPI: 1699111450
Provider Name (Legal Business Name): CAITLIN ANN WRYCZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 KIRMAN AVE
RENO NV
89502-0993
US

IV. Provider business mailing address

1675 SKY MOUNTAIN DR APT 736
RENO NV
89523-8105
US

V. Phone/Fax

Practice location:
  • Phone: 608-234-2988
  • Fax:
Mailing address:
  • Phone: 608-234-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8144-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128452-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: