Healthcare Provider Details

I. General information

NPI: 1528122082
Provider Name (Legal Business Name): MRS. AMY GIBBONS TITZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY CLAIRE GIBBONS

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 KAREN CT
LITITZ PA
17543-9243
US

IV. Provider business mailing address

43 KAREN CT
LITITZ PA
17543-9243
US

V. Phone/Fax

Practice location:
  • Phone: 717-742-2003
  • Fax:
Mailing address:
  • Phone: 717-742-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: