MEDICARE: PHILIP V GIBLIN MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	2005001137	MO

General Provider Information

NPI Number	:	1306822515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP V GIBLIN MSW, LCSW

Provider Business Mailing Address
First Line	:	23576 SNOWBIRD DR
Second Line	:
City	:	LEBANON
State	:	MO
Zip	:	65536-6460
Country	:	US
Telephone Number	:	417-588-2719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 DEADRA DR
Second Line	:
City	:	LEBANON
State	:	MO
Zip	:	65536-4669
Country	:	US
Telephone Number	:	417-532-7102
Fax Number	:	417-532-6606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	07/08/2007

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