Healthcare Provider Details

I. General information

NPI: 1861975617
Provider Name (Legal Business Name): KAIN PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 01/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PANTHER LN STE 223
NAPLES FL
34109-7874
US

IV. Provider business mailing address

2316 PINE RIDGE RD STE 334
NAPLES FL
34109-2006
US

V. Phone/Fax

Practice location:
  • Phone: 239-593-6112
  • Fax:
Mailing address:
  • Phone: 239-398-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7579
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PAMELA SUE KAIN
Title or Position: SOLE MEMBER
Credential: PSYD
Phone: 239-398-0337