Provider Demographics
NPI:1821600123
Name:GAINES, JOSEPH HERBERT (LPC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HERBERT
Last Name:GAINES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WAGON LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1560
Mailing Address - Country:US
Mailing Address - Phone:267-438-1031
Mailing Address - Fax:
Practice Address - Street 1:2101 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2941
Practice Address - Country:US
Practice Address - Phone:215-400-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional