Provider Demographics
NPI:1245204825
Name:BAYNES, KATHLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:BAYNES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:1544 NEWTON CT
Mailing Address - Street 2:CENTER FOR NEUROSCIENCE
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4859
Mailing Address - Country:US
Mailing Address - Phone:530-757-8850
Mailing Address - Fax:530-757-8827
Practice Address - Street 1:10633 GRISSOM AVE
Practice Address - Street 2:SACRAMENTO VA MENTAL HEALTH CLINIC
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-4123
Practice Address - Country:US
Practice Address - Phone:916-366-5420
Practice Address - Fax:916-366-5325
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA15157103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist