Provider Demographics
NPI:1932332160
Name:RAYNOR, GAIL PAVEK (MA)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:PAVEK
Last Name:RAYNOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:GAEL
Other - Middle Name:SHARON
Other - Last Name:PAVEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:8527 BOTHWELL RD.
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324
Mailing Address - Country:US
Mailing Address - Phone:818-772-8969
Mailing Address - Fax:
Practice Address - Street 1:8527 BOTHWELL RD.
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324
Practice Address - Country:US
Practice Address - Phone:818-772-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC8705106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist