Provider Demographics
NPI:1366262941
Name:CAFFREY, KATHLYNN MAUREEN (PMHNP)
Entity type:Individual
Prefix:
First Name:KATHLYNN
Middle Name:MAUREEN
Last Name:CAFFREY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-1462
Mailing Address - Country:US
Mailing Address - Phone:586-217-7285
Mailing Address - Fax:
Practice Address - Street 1:1460 WALTON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1779
Practice Address - Country:US
Practice Address - Phone:248-844-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704315379363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health