Provider Demographics
NPI:1366917536
Name:DENNIS, CAITLINE
Entity type:Individual
Prefix:
First Name:CAITLINE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATY
Other - Middle Name:
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7925 RIO LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:ELVERTA
Mailing Address - State:CA
Mailing Address - Zip Code:95626-9652
Mailing Address - Country:US
Mailing Address - Phone:916-751-8387
Mailing Address - Fax:
Practice Address - Street 1:7925 RIO LINDA BLVD
Practice Address - Street 2:
Practice Address - City:ELVERTA
Practice Address - State:CA
Practice Address - Zip Code:95626-9652
Practice Address - Country:US
Practice Address - Phone:916-751-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician