Individual
DR. CAREY E LAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
11327 WILLOW VALLEY RD, STE A, NEVADA CITY, CA 95959-8623
(530) 277-0976
(833) 900-1392
Mailing address
PO BOX 1288, NEVADA CITY, CA 95959-1288
(530) 277-0976
(833) 900-1392
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 21635
CA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY 21635
CA
103TE1100X
Exercise & Sports Psychologist
PSY 21635
CA
103TF0000X
Family Psychologist
PSY 21635
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12290214
CAQH
CA
01
—
OPL 216 350
BLUE SHIELD
CA
Enumeration date
07/13/2005
Last updated
12/04/2019
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