Provider Information for 1821600123
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Mr. JOSEPH HERBERT GAINES LPC
Sex: Male
NPI: 1821600123
Last Updated: 2020-08-18
Certification Date: 2020-08-18
Certification Date: 2020-08-18
Details
| Name | Value | ||||||||
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| NPI | 1821600123 | ||||||||
| Enumeration Date | 2020-08-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 40 WAGON LN CHERRY HILL, NJ 08002-1560 United States Phone: 267-438-1031 | Fax: | ||||||||
| Primary Practice Address | 2101 S BROAD ST PHILADELPHIA, PA 19148-2941 United States Phone: 215-400-8400 | Fax: | ||||||||
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