Provider Demographics
NPI:1316079692
Name:GIBBONS, DEBORAH L (LPC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 GRANDVIEW AVE
Mailing Address - Street 2:BEHAVIORAL HEALTH
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2509
Mailing Address - Country:US
Mailing Address - Phone:203-573-6103
Mailing Address - Fax:203-573-7578
Practice Address - Street 1:64 ROBBINS ST
Practice Address - Street 2:CRISIS CENTER
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2613
Practice Address - Country:US
Practice Address - Phone:203-573-6103
Practice Address - Fax:203-573-7578
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional