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General NPI Number Information
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NPI Number | 1134375363
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Entity Type | Organization
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Legal Business Name | BERTRAM GIBBES, PH.D., INC.
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 481A KINGSTOWN RD SUITE D
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City | WAKEFIELD
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State | RI
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Zip | 02879-3607
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Country | US
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Telephone | 401-782-1667
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Fax | 104-782-1669
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Provider Business Mailing Address
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Address Line | 481A KINGSTOWN RD SUITE D
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City | WAKEFIELD
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State | RI
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Zip | 02879-3607
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Country | US
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Telephone | 401-782-1667
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Fax | 401-782-1669
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Authorized Official
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Title or Position | PRESIDENT
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Name | BERTRAM ST. CYR LINARD GIBBES
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Credential | PH.D.
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Telephone | 401-782-1667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS00511
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License Number State | RI
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