Provider Demographics
NPI:1306691969
Name:CAREY LAINE PSYCHOLOGIST,INC.
Entity type:Organization
Organization Name:CAREY LAINE PSYCHOLOGIST,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAINE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:530-277-0976
Mailing Address - Street 1:11327 WILLOW VALLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8623
Mailing Address - Country:US
Mailing Address - Phone:530-277-0976
Mailing Address - Fax:530-470-6021
Practice Address - Street 1:11327 WILLOW VALLEY RD STE A
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-8623
Practice Address - Country:US
Practice Address - Phone:530-277-0976
Practice Address - Fax:530-470-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty