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General NPI Number Information
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NPI Number | 1841752847
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Entity Type | Individual
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Provider Name | LORICA GIBSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 19 DEWITT ST
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City | MIDDLETOWN
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State | NY
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Zip | 10940-3913
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Country | US
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Telephone | 845-820-0997
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Fax | 845-524-4740
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Provider Business Mailing Address
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Address Line | 130 WEED RD
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City | PINE BUSH
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State | NY
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Zip | 12566-7460
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Country | US
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Telephone | 845-820-0997
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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 | 102158-1
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License Number State | NY
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