Healthcare Provider Details

I. General information

NPI: 1346482650
Provider Name (Legal Business Name): KATY DRORIT GAINES M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 CRICKETFIELD CT
LAKE SHERWOOD CA
91361-5154
US

IV. Provider business mailing address

548 CRICKETFIELD CT
LAKE SHERWOOD CA
91361-5154
US

V. Phone/Fax

Practice location:
  • Phone: 818-961-4045
  • Fax:
Mailing address:
  • Phone: 818-961-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: