Healthcare Provider Details

I. General information

NPI: 1326705609
Provider Name (Legal Business Name): CAITLIN EAMOTTE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 NESCONSET HWY STE 105
LAKE GROVE NY
11755-1000
US

IV. Provider business mailing address

1108 VILLAGE DR APT B
RIDGE NY
11961-8306
US

V. Phone/Fax

Practice location:
  • Phone: 631-306-4284
  • Fax:
Mailing address:
  • Phone: 631-745-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number108255
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108255
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: