Provider Demographics
NPI:1932118114
Name:GAINES, HARRY MALCOLM JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:MALCOLM
Last Name:GAINES
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3972 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3704
Mailing Address - Country:US
Mailing Address - Phone:415-254-0755
Mailing Address - Fax:415-358-4273
Practice Address - Street 1:3972 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3704
Practice Address - Country:US
Practice Address - Phone:415-254-0755
Practice Address - Fax:415-358-4273
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19812103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent