Individual provider Active NPI

Latoya Gaines, PSY.D.

  • Clinical Psychologist
  • Baltimore, MD
National Provider Identifier
1396201737
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
07045 Issued in MD
Practice address
707 N Broadway
Baltimore, MD 21205-1832
Phone
(201) 486-4518
NPI assigned
Feb 11, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 07045 MD Primary
Clinical Psychologist 103TC0700X 023079 NY

Addresses

Primary practice location

707 N Broadway
Baltimore, MD 21205-1832

Mailing address

1741 Ashland Ave
Baltimore, MD 21205-1531
Phone (443) 923-1842

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240103001193 MD Practitioner - Clinical Psychologist 3173973112 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
023079NYMDClinical Psychologist
07045MDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Culture of Wellness, LLC Current Accepting new patients
Kennedy Krieger Associates CurrentSince Nov 15, 2023 Accepting new patients
Kennedy Krieger Associates CurrentSince Nov 15, 2023 Accepting new patients

Locations

707 N Broadway
Baltimore, MD 21205
Phone (443) 923-1870

1741 Ashland Ave
Ste 642
Baltimore, MD 21205

1741 Ashland Ave
Baltimore, MD 21205
Phone (443) 923-1842

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1396201737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1741 ASHLAND AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212051531",
            "telephone_number": "443-923-1842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N BROADWAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212051832",
            "telephone_number": "201-486-4518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAINES",
        "first_name": "LATOYA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-11",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "07045",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "023079",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.