Provider Demographics
NPI:1942054366
Name:GAINES, YEIMNY AGRIPINA (LSW)
Entity Type:Individual
Prefix:
First Name:YEIMNY
Middle Name:AGRIPINA
Last Name:GAINES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 FARNSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1709
Mailing Address - Country:US
Mailing Address - Phone:609-284-1075
Mailing Address - Fax:
Practice Address - Street 1:328 FARNSWORTH AVE
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1709
Practice Address - Country:US
Practice Address - Phone:609-535-3404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL070819001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical