Provider Demographics
NPI:1528650405
Name:GRASSON, CAITLIN (LMFT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:GRASSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 30TH RD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3640
Mailing Address - Country:US
Mailing Address - Phone:256-684-0269
Mailing Address - Fax:
Practice Address - Street 1:243 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY SOUTH
Practice Address - State:NY
Practice Address - Zip Code:11530-5532
Practice Address - Country:US
Practice Address - Phone:516-303-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist