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General NPI Number Information
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NPI Number | 1699521450
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Entity Type | Individual
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Provider Name | LISA GIBSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/24/2024
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 134 N 4TH ST
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City | BROOKLYN
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State | NY
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Zip | 11249-3296
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Country | US
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Telephone | 914-640-0799
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Fax |
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Provider Business Mailing Address
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Address Line | 1413 HIGHWAY 17 S # 364
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City | SURFSIDE BEACH
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State | SC
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Zip | 29575-6040
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Country | US
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Telephone | 914-640-0799
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 068169
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License Number State | NY
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