Provider Demographics
NPI:1164046884
Name:GAINEY, MARY TERESA (RBT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TERESA
Last Name:GAINEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4719
Mailing Address - Country:US
Mailing Address - Phone:912-399-4247
Mailing Address - Fax:912-574-5919
Practice Address - Street 1:2300 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4719
Practice Address - Country:US
Practice Address - Phone:912-399-4247
Practice Address - Fax:912-574-5919
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-119849106S00000X
GA1-21-51994103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician