Provider Demographics
NPI:1114726577
Name:ITH, CAITLIN MIRRAYE
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MIRRAYE
Last Name:ITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 QUINNS CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3025
Mailing Address - Country:US
Mailing Address - Phone:860-284-8467
Mailing Address - Fax:
Practice Address - Street 1:11 QUINNS CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3025
Practice Address - Country:US
Practice Address - Phone:860-284-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician