MEDICARE: MS. DOROTHY B GIBBONS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CWO13936	PA

General Provider Information

NPI Number	:	1437272390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOROTHY B GIBBONS LCSW

Provider Business Mailing Address
First Line	:	6240 CRAFTON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-3509
Country	:	US
Telephone Number	:	267-307-8428
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 CHESTNUT ST
Second Line	:	SUITE 801
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-3713
Country	:	US
Telephone Number	:	267-307-8428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	07/08/2007

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