Provider Demographics
NPI:1104906320
Name:GAINES, JOAN GOLLIN (JOAN GAINES, PHD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:GOLLIN
Last Name:GAINES
Suffix:
Gender:F
Credentials:JOAN GAINES, PHD
Other - Prefix:DR
Other - First Name:JOAN
Other - Middle Name:G
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:7321 SW 108TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3853
Mailing Address - Country:US
Mailing Address - Phone:305-665-1099
Mailing Address - Fax:305-665-7944
Practice Address - Street 1:1450 MADRUGA AVE
Practice Address - Street 2:310
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3148
Practice Address - Country:US
Practice Address - Phone:305-663-5808
Practice Address - Fax:305-663-5809
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004309103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73747Medicare ID - Type Unspecified