Healthcare Provider Details

I. General information

NPI: 1407771355
Provider Name (Legal Business Name): SETH GAINES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 N PALMYRA RD
CANFIELD OH
44406-9709
US

IV. Provider business mailing address

7320 N PALMYRA RD
CANFIELD OH
44406-9709
US

V. Phone/Fax

Practice location:
  • Phone: 330-533-8755
  • Fax:
Mailing address:
  • Phone: 330-533-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH3361770
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: