Provider Demographics
NPI:1346482650
Name:GAINES, KATY DRORIT (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:DRORIT
Last Name:GAINES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 CRICKETFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LAKE SHERWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5154
Mailing Address - Country:US
Mailing Address - Phone:818-961-4045
Mailing Address - Fax:
Practice Address - Street 1:548 CRICKETFIELD CT
Practice Address - Street 2:
Practice Address - City:LAKE SHERWOOD
Practice Address - State:CA
Practice Address - Zip Code:91361-5154
Practice Address - Country:US
Practice Address - Phone:818-961-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26943103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical