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General NPI Number Information
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NPI Number | 1073233714
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Entity Type | Individual
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Provider Name | JEANETTE M GIBSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 570 BLOSSOM HILL RD
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City | SAN JOSE
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State | CA
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Zip | 95123-3212
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Country | US
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Telephone | 855-799-4647
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Fax | 669-223-8255
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Provider Business Mailing Address
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Address Line | PO BOX 888
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City | TRACY
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State | CA
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Zip | 95378-0888
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Country | US
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Telephone | 209-650-0896
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 101081
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License Number State | CA
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