MEDICARE: CAREY LAINE PSYCHOLOGIST,INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1306691969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREY LAINE PSYCHOLOGIST,INC.

Provider Business Mailing Address
First Line	:	11327 WILLOW VALLEY RD STE A
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-8623
Country	:	US
Telephone Number	:	530-277-0976
Fax Number	:	530-470-6021

Provider Business Practice Location Address
First Line	:	11327 WILLOW VALLEY RD STE A
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-8623
Country	:	US
Telephone Number	:	530-277-0976
Fax Number	:	530-470-6021

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CAREY E LAINE
Credential	:	PSYD
Telephone Number	:	530-277-0976

Provider Enumeration Date	:	04/18/2024
Last Update Date	:	04/18/2024

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