Healthcare Provider Details

I. General information

NPI: 1104906320
Provider Name (Legal Business Name): JOAN GOLLIN GAINES JOAN GAINES, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOAN G GAINES PH.D.

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MADRUGA AVE 310
CORAL GABLES FL
33146-3148
US

IV. Provider business mailing address

7321 SW 108TH TER
MIAMI FL
33156-3853
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-5808
  • Fax: 305-663-5809
Mailing address:
  • Phone: 305-665-1099
  • Fax: 305-665-7944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0004309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: