Healthcare Provider Details

I. General information

NPI: 1285665547
Provider Name (Legal Business Name): KATHLEEN MARIE DEVLIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23461 S POINTE DR SUITE 220
LAGUNA HILLS CA
92653-1547
US

IV. Provider business mailing address

15333 CULVER DRIVE SUITE 340 #2212
IRVINE CA
92604-1547
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-1556
  • Fax: 949-951-2871
Mailing address:
  • Phone: 949-701-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: