Provider Demographics
NPI:1104247345
Name:GIBSON, ERINNE
Entity type:Individual
Prefix:
First Name:ERINNE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:NY
Mailing Address - Zip Code:14871-9108
Mailing Address - Country:US
Mailing Address - Phone:607-331-3121
Mailing Address - Fax:
Practice Address - Street 1:1520 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:NY
Practice Address - Zip Code:14871-9108
Practice Address - Country:US
Practice Address - Phone:607-331-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst