Healthcare Provider Details

I. General information

NPI: 1194641399
Provider Name (Legal Business Name): HADLEY GIBSON LMSW-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 US ROUTE 1 STE 23
FREEPORT ME
04032-7022
US

IV. Provider business mailing address

10 HORNET ST
BRUNSWICK ME
04011-2717
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-1675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC26168
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: