Caitlin L Conklin, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-11-7979 Issued in CA

Practice address

4444 Acacia Way
Penngrove, CA 94951-9731

Phone

(707) 776-7747

Fax

(888) 330-9483

NPI assigned

Jun 14, 2011

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 9, 2014.

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404864000000",
    "number": "1780979161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4444 ACACIA WAY",
            "city": "PENNGROVE",
            "state": "CA",
            "postal_code": "949519731",
            "telephone_number": "707-776-7747",
            "fax_number": "888-330-9483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 ACACIA WAY",
            "city": "PENNGROVE",
            "state": "CA",
            "postal_code": "949519731",
            "telephone_number": "707-776-7747",
            "fax_number": "888-330-9483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONKLIN",
        "first_name": "CAITLIN",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-14",
        "last_updated": "2014-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-11-7979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Aicega, MFT/LPCC
• Kimberly Ann Brasil
• Kristen Ann Cheung, LCSW, CT
• Magdalena Eschenberg, DOULA
• Gretchen F Forrey, M.A.
• Natalie Diane Hole, M.S., CCC-SLP
• Brittny Johnson
• Florence Landau, MA MFT

• All providers in Penngrove, CA
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.