Healthcare Provider Details

I. General information

NPI: 1801535810
Provider Name (Legal Business Name): CAITLYN WUNDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BARCLAY STREET
NEWTOWN PA
18940
US

IV. Provider business mailing address

444 S. STATE STREET NEWTOWN, PA 18940 BUILDING A
NEWTOWN PA
18954
US

V. Phone/Fax

Practice location:
  • Phone: 267-755-9333
  • Fax:
Mailing address:
  • Phone: 267-755-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: