Healthcare Provider Details

I. General information

NPI: 1760292460
Provider Name (Legal Business Name): REBECCA GIBBONS, NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAMARONECK AVE STE 400
HARRISON NY
10528-1613
US

IV. Provider business mailing address

600 MAMARONECK AVE STE 400
HARRISON NY
10528-1613
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-1112
  • Fax: 914-259-5509
Mailing address:
  • Phone: 914-848-1112
  • Fax: 914-259-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REBECCA M GIBBONS
Title or Position: CEO
Credential: PMHNP-BC
Phone: 914-848-1112