Healthcare Provider Details

I. General information

NPI: 1740382407
Provider Name (Legal Business Name): MARK ANDREW GAINEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 01/31/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST PETERSBURG BEHAVIORAL HEALTH CENTER 3551 42ND AVE S STE B107
ST PETERSBURG FL
33711-4369
US

IV. Provider business mailing address

ST PETERSBURG BEHAVIORAL HEALTH CENTER 3551 42ND AVE S STE B107
ST PETERSBURG FL
33711-4369
US

V. Phone/Fax

Practice location:
  • Phone: 727-895-8498
  • Fax: 727-895-8497
Mailing address:
  • Phone: 727-895-8498
  • Fax: 727-895-8497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW2998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: