Provider Demographics
NPI:1437290699
Name:ELISABETH CAETANO
Entity type:Organization
Organization Name:ELISABETH CAETANO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAETANO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:619-687-9013
Mailing Address - Street 1:9330 CARMEL MOUNTAIN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2157
Mailing Address - Country:US
Mailing Address - Phone:619-687-9013
Mailing Address - Fax:
Practice Address - Street 1:9330 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2157
Practice Address - Country:US
Practice Address - Phone:619-687-9013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty