Provider Demographics
NPI:1386976595
Name:GAINES, CYNTHIA LEE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LEE
Last Name:GAINES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2031
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-2031
Mailing Address - Country:US
Mailing Address - Phone:760-514-6140
Mailing Address - Fax:760-241-2848
Practice Address - Street 1:13035 WRANGLER LN
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-6346
Practice Address - Country:US
Practice Address - Phone:760-514-6140
Practice Address - Fax:760-241-2848
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW 27098OtherBBS