MEDICARE: MR. JOSEPH HERBERT GAINES LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC009381	PA

General Provider Information

NPI Number	:	1821600123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH HERBERT GAINES LPC

Provider Business Mailing Address
First Line	:	40 WAGON LN
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08002-1560
Country	:	US
Telephone Number	:	267-438-1031
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2941
Country	:	US
Telephone Number	:	215-400-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/18/2020

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