Provider Demographics
NPI:1679522890
Name:GAINES, ROSALIND E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSALIND
Middle Name:E
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:PO BOX 220627
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33422-0627
Mailing Address - Country:US
Mailing Address - Phone:561-684-1991
Mailing Address - Fax:561-684-8582
Practice Address - Street 1:5841 CORPORATE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2039
Practice Address - Country:US
Practice Address - Phone:561-684-1991
Practice Address - Fax:561-684-8582
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW35161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6481ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER