Provider Demographics
NPI:1861709263
Name:VAUGHAN, CAROLYN KAY (PSY D)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:KAY
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 151717
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94915-1717
Mailing Address - Country:US
Mailing Address - Phone:415-457-9754
Mailing Address - Fax:415-482-8148
Practice Address - Street 1:425 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2231
Practice Address - Country:US
Practice Address - Phone:415-389-7711
Practice Address - Fax:415-389-7780
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24951103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist