Healthcare Provider Details

I. General information

NPI: 1992363527
Provider Name (Legal Business Name): DEBRA GIBBS LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W 23RD ST FL 5
NEW YORK NY
10011-2599
US

IV. Provider business mailing address

74 S PORTLAND AVE APT 1
BROOKLYN NY
11217-1302
US

V. Phone/Fax

Practice location:
  • Phone: 917-780-2171
  • Fax:
Mailing address:
  • Phone: 347-835-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number002037-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: