Provider Demographics
NPI:1588311070
Name:HARTSHORN, CAITLYN ELIZABETH
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:ELIZABETH
Last Name:HARTSHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CLYDE ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-5102
Mailing Address - Country:US
Mailing Address - Phone:802-528-6057
Mailing Address - Fax:
Practice Address - Street 1:35 CLYDE ALLEN DR
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-5102
Practice Address - Country:US
Practice Address - Phone:802-528-6057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health