Healthcare Provider Details

I. General information

NPI: 1568297687
Provider Name (Legal Business Name): KEREEN GIBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MAIN ST FL 3
YONKERS NY
10701-2739
US

IV. Provider business mailing address

55 MAIN ST FL 3
YONKERS NY
10701-2739
US

V. Phone/Fax

Practice location:
  • Phone: 914-327-5588
  • Fax:
Mailing address:
  • Phone: 914-327-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P130839-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: