Provider Demographics
NPI:1154672848
Name:GAINES, ANDREW M (LCAT, RDT-BCT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:M
Last Name:GAINES
Suffix:
Gender:M
Credentials:LCAT, RDT-BCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 PINEAPPLE ST
Mailing Address - Street 2:APT 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1773
Mailing Address - Country:US
Mailing Address - Phone:917-674-8283
Mailing Address - Fax:
Practice Address - Street 1:59 PINEAPPLE ST
Practice Address - Street 2:APT 2L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1773
Practice Address - Country:US
Practice Address - Phone:917-674-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001043-1101YP2500X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator