MEDICARE: PAMELA MARIE GIBSON 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	171M00000X	Case Manager/Care Coordinator
2	1041C0700X	Clinical Social Worker	09925548	CO

General Provider Information

NPI Number	:	1598274060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA MARIE GIBSON LCSW

Provider Business Mailing Address
First Line	:	205 RALEIGH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-1251
Country	:	US
Telephone Number	:	623-225-5898
Fax Number	:

Provider Business Practice Location Address
First Line	:	2560 SHERIDAN BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80214-3011
Country	:	US
Telephone Number	:	303-504-7801
Fax Number	:

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

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	11/18/2022

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