MEDICARE: KAITLIN MICHELLE DORAN PSYD.

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	103T00000X	Psychologist	27590	CA
2	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1548522873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN MICHELLE DORAN PSYD.

Provider Business Mailing Address
First Line	:	16070 SELBORNE DR
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-1129
Country	:	US
Telephone Number	:	510-798-5148
Fax Number	:

Provider Business Practice Location Address
First Line	:	2095 VAN NESS AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-3009
Country	:	US
Telephone Number	:	415-423-1523
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	02/18/2021

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