Provider Demographics
NPI:1518112945
Name:GAINES, DENISE KATHLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:KATHLEEN
Last Name:GAINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N CENTRAL AVE
Mailing Address - Street 2:SUITE 2350
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2425
Mailing Address - Country:US
Mailing Address - Phone:602-955-8283
Mailing Address - Fax:
Practice Address - Street 1:4647 N 32ND ST
Practice Address - Street 2:SUITE 255
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3345
Practice Address - Country:US
Practice Address - Phone:602-955-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-03001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical