Healthcare Provider Details

I. General information

NPI: 1538618608
Provider Name (Legal Business Name): CAITLIN MALOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 TROY SCHENECTADY RD STE 204
LATHAM NY
12110-1000
US

IV. Provider business mailing address

1182 TROY SCHENECTADY RD STE 204
LATHAM NY
12110-1000
US

V. Phone/Fax

Practice location:
  • Phone: 518-400-5180
  • Fax: 518-940-4420
Mailing address:
  • Phone: 518-400-5180
  • Fax: 518-940-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: