1740382407 NPI number — MR. MARK ANDREW GAINEY LCSW

Table of content: MR. MARK ANDREW GAINEY LCSW (NPI 1740382407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740382407 NPI number — MR. MARK ANDREW GAINEY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAINEY
Provider First Name:
MARK
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740382407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ST PETERSBURG BEHAVIORAL HEALTH CENTER
Provider Second Line Business Mailing Address:
3551 42ND AVE S STE B107
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33711-4369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-895-8498
Provider Business Mailing Address Fax Number:
727-895-8497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST PETERSBURG BEHAVIORAL HEALTH CENTER
Provider Second Line Business Practice Location Address:
3551 42ND AVE S STE B107
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33711-4369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-895-8498
Provider Business Practice Location Address Fax Number:
727-895-8497
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  SW2998 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002245900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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