Provider Demographics
NPI:1124489315
Name:GAINEY & ROVERATO THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:GAINEY & ROVERATO THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARISSE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:919-423-0465
Mailing Address - Street 1:261 TADCASTER CT
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6623
Mailing Address - Country:US
Mailing Address - Phone:919-423-0465
Mailing Address - Fax:
Practice Address - Street 1:261 TADCASTER CT
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-6623
Practice Address - Country:US
Practice Address - Phone:919-423-0465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7513235Z00000X
NC7297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty