Healthcare Provider Details

I. General information

NPI: 1952486086
Provider Name (Legal Business Name): ALAN FREDERICK CAULDWELL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W 86TH ST #208
NEW YORK NY
10024-3616
US

IV. Provider business mailing address

25 FAIRFIELD RD
GREENWICH CT
06830-4833
US

V. Phone/Fax

Practice location:
  • Phone: 212-799-8614
  • Fax:
Mailing address:
  • Phone: 203-661-1547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR031487
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002793
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: