Healthcare Provider Details

I. General information

NPI: 1376776682
Provider Name (Legal Business Name): LAUREN OLIVIA GIBSON-CARTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BARNARD LN SUITE 107
BLOOMFIELD CT
06002-2452
US

IV. Provider business mailing address

3 BARNARD LN SUITE 107
BLOOMFIELD CT
06002-2452
US

V. Phone/Fax

Practice location:
  • Phone: 860-874-9995
  • Fax: 860-578-9173
Mailing address:
  • Phone: 860-874-9995
  • Fax: 860-578-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005784
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: