Healthcare Provider Details

I. General information

NPI: 1235575762
Provider Name (Legal Business Name): PAUL GAINES JR. MSW, LICSW, M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 SAN ERNESTO AVE APT 4
ANCHORAGE AK
99508-2829
US

IV. Provider business mailing address

3721 B STREET UNIT 240851
ANCHORAGE AK
99524-0851
US

V. Phone/Fax

Practice location:
  • Phone: 385-309-3999
  • Fax:
Mailing address:
  • Phone: 401-855-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW121658
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02768
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103417
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierISW02768
Identifier TypeOTHER
Identifier StateRI
Identifier IssuerLICSW
# 2
Identifier121658
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerLICSW
# 3
Identifier103417
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerLCSW

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: