Provider Demographics
NPI:1992974299
Name:CAFFEE, KRISTAN SUZANNE (LCSW, LSCSW)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:SUZANNE
Last Name:CAFFEE
Suffix:
Gender:F
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W 9TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2846
Mailing Address - Country:US
Mailing Address - Phone:785-925-7865
Mailing Address - Fax:
Practice Address - Street 1:708 W 9TH ST STE 103
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2846
Practice Address - Country:US
Practice Address - Phone:785-925-7865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
KSLSCSW059871041C0700X
CALCS26065104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical