Provider Demographics
NPI:1285235408
Name:GAINES, KEARISTEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:KEARISTEN
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 BOARDMAN CANFIELD RD STE 203
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4235
Mailing Address - Country:US
Mailing Address - Phone:330-779-1333
Mailing Address - Fax:
Practice Address - Street 1:860 BOARDMAN CANFIELD RD STE 203
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4235
Practice Address - Country:US
Practice Address - Phone:330-779-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08079103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical