Provider Demographics
NPI:1023228004
Name:GAINES, GRETCHEN P (MSW,LCSW-C)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:P
Last Name:GAINES
Suffix:
Gender:F
Credentials:MSW,LCSW-C
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:GAINES
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW,LCSW-C
Mailing Address - Street 1:11433 ENCORE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-5060
Mailing Address - Country:US
Mailing Address - Phone:301-681-5964
Mailing Address - Fax:301-681-5964
Practice Address - Street 1:11433 ENCORE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-5060
Practice Address - Country:US
Practice Address - Phone:301-681-5964
Practice Address - Fax:301-681-5964
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD041811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDIDFLA662431Medicare UPIN
MDIDFLA662434Medicare ID - Type UnspecifiedMEDICARE