Provider Demographics
NPI:1164312369
Name:COLDITZ, CAITLIN NATALIE (LAC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:NATALIE
Last Name:COLDITZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2817
Mailing Address - Country:US
Mailing Address - Phone:201-256-5823
Mailing Address - Fax:
Practice Address - Street 1:584 STATE RT 17
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2000
Practice Address - Country:US
Practice Address - Phone:201-556-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00886900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health