Healthcare Provider Details

I. General information

NPI: 1215890967
Provider Name (Legal Business Name): CAITLIN MARIE GAYLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHMOND SQ STE 350W
PROVIDENCE RI
02906-5165
US

IV. Provider business mailing address

1 RICHMOND SQ STE 350W
PROVIDENCE RI
02906-5165
US

V. Phone/Fax

Practice location:
  • Phone: 401-227-0372
  • Fax: 877-455-9466
Mailing address:
  • Phone: 401-227-0372
  • Fax: 877-455-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: