Provider Demographics
NPI:1215339627
Name:GIBBS, DOREEN
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:GIBBS
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 1:12926 243RD ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1145
Mailing Address - Country:US
Mailing Address - Phone:347-733-4215
Mailing Address - Fax:718-749-5912
Practice Address - Street 1:12926 243RD ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1145
Practice Address - Country:US
Practice Address - Phone:347-733-4215
Practice Address - Fax:718-749-5912
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health