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NPI Code Detail

MEDICARE: AMANDA GIBSON LCSW

MEDICARE: AMANDA GIBSON 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
11041C0700XClinical Social Worker20197CA
21041C0700XClinical Social WorkerLCS25790CA
3101YM0800XMental Health Counselor25790CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790888998
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA GIBSON LCSW
Provider Business Mailing Address
First Line : 2617 K ST STE 125
Second Line :
City : SACRAMENTO
State : CA
Zip : 95816-5133
Country : US
Telephone Number : 916-425-3311
Fax Number :
Provider Business Practice Location Address
First Line : 2617 K ST STE 125
Second Line :
City : SACRAMENTO
State : CA
Zip : 95816-5133
Country : US
Telephone Number : 916-425-3311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2006
Last Update Date : 03/20/2023

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Directions to “ AMANDA GIBSON LCSW” Practice Location

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