Provider Demographics
NPI:1124469663
Name:GINWALA, CAITLIN NEWCOMB (LMFT96759)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:NEWCOMB
Last Name:GINWALA
Suffix:
Gender:F
Credentials:LMFT96759
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:COLLEEN
Other - Last Name:NEWCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 124611
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92112-4611
Mailing Address - Country:US
Mailing Address - Phone:805-501-6723
Mailing Address - Fax:
Practice Address - Street 1:921 W AVENUE J STE C
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3443
Practice Address - Country:US
Practice Address - Phone:661-949-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF74289101YM0800X
CA74289106H00000X
CA96759106H00000X
CALMFT96759106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health