Provider Demographics
NPI:1255582870
Name:ERWIN, GWYNETH KERR (PHD, PSYD)
Entity type:Individual
Prefix:DR
First Name:GWYNETH
Middle Name:KERR
Last Name:ERWIN
Suffix:
Gender:F
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7724
Mailing Address - Country:US
Mailing Address - Phone:714-508-0804
Mailing Address - Fax:714-543-6094
Practice Address - Street 1:250 W MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7724
Practice Address - Country:US
Practice Address - Phone:714-508-0804
Practice Address - Fax:714-543-6094
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARP 0070102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst