Basic Information
| Provider Information | |||||||||
| NPI: | 1174104400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDMOND | ||||||||
| FirstName: | CAITLIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4884 E RIVER RD | ||||||||
| Address2: | |||||||||
| City: | WEST HENRIETTA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145869710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852019094 | ||||||||
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| Practice Location | |||||||||
| Address1: | 89 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146113201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857237000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2021 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 111267-01 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.