Provider Demographics
NPI:1629354931
Name:GAINES, BARBARA (MACCC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:MACCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1662
Mailing Address - Country:US
Mailing Address - Phone:914-428-2193
Mailing Address - Fax:
Practice Address - Street 1:411 THEODORE FREMD AVE
Practice Address - Street 2:RYE CITY SCHOOL DISTRICT
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580
Practice Address - Country:US
Practice Address - Phone:914-967-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58001466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01384101Medicaid