Active NPI
Elizabeth Chilton Gaines, PSY.D.
- Clinical Psychologist
- Placentia, CA
National Provider Identifier
1679692362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY19272
- Practice address
- 1702 Stanley Ave
Placentia, CA 92870-2423 - Phone
- (310) 625-6408
- NPI assigned
- Mar 27, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY19272 | CA | Primary |
Addresses
Primary practice location
1702 Stanley Ave
Placentia, CA 92870-2423
Mailing address
210 S Illinois St Apt 3
Anaheim, CA 92805-3644
Phone (310) 625-6408
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 19, 2024 through Feb 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY19272 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707091200000",
"number": "1679692362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 S ILLINOIS ST APT 3",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928053644",
"telephone_number": "310-625-6408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1702 STANLEY AVE",
"city": "PLACENTIA",
"state": "CA",
"postal_code": "928702423",
"telephone_number": "310-625-6408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAINES",
"first_name": "ELIZABETH",
"middle_name": "CHILTON",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-27",
"last_updated": "2024-02-05",
"certification_date": "2024-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY19272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Placentia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.