Provider Demographics
NPI:1073761250
Name:RAINES, KRISTINA CATHERINE ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:CATHERINE ANNE
Last Name:RAINES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 ANDOVER F
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-2632
Mailing Address - Country:US
Mailing Address - Phone:803-924-6893
Mailing Address - Fax:
Practice Address - Street 1:3180 CENTER ST NE STE 2100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4592
Practice Address - Country:US
Practice Address - Phone:503-588-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-30
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP19537Medicare UPIN