Provider Demographics
NPI:1104547751
Name:GIBBONS, REBECCA M (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:M
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 MAMARONECK AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1613
Mailing Address - Country:US
Mailing Address - Phone:914-848-1112
Mailing Address - Fax:914-259-5509
Practice Address - Street 1:600 MAMARONECK AVE STE 400
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1613
Practice Address - Country:US
Practice Address - Phone:914-848-1112
Practice Address - Fax:914-259-5509
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404086363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health