Provider Demographics
NPI:1760909600
Name:POWER, KAITLYN (LCSW)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:POWER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 W MANCHESTER AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8449
Mailing Address - Country:US
Mailing Address - Phone:213-374-0541
Mailing Address - Fax:
Practice Address - Street 1:7740 W MANCHESTER AVE STE 109
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8449
Practice Address - Country:US
Practice Address - Phone:213-374-0541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health