Healthcare Provider Details

I. General information

NPI: 1659979607
Provider Name (Legal Business Name): ANTHONY J GIBSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 JACKSON AVE
SEAFORD NY
11783-2606
US

IV. Provider business mailing address

857 S OYSTER BAY RD
BETHPAGE NY
11714-1030
US

V. Phone/Fax

Practice location:
  • Phone: 516-222-8888
  • Fax:
Mailing address:
  • Phone: 516-987-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100692
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: