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NPI Code Detail

MEDICARE: DR. ELISABETH NICHOLAS GIBBINGS PSY.D.

MEDICARE: DR. ELISABETH NICHOLAS GIBBINGS PSY.D.
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
1103TC0700XClinical PsychologistPS005785LPA

General Provider Information

NPI Number : 1679677090
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELISABETH NICHOLAS GIBBINGS PSY.D.
Provider Business Mailing Address
First Line : 1 UNIVERSITY PL
Second Line : WIDENER UNIVERSITY
City : CHESTER
State : PA
Zip : 19013-5792
Country : US
Telephone Number : 610-499-1221
Fax Number : 610-499-4625
Provider Business Practice Location Address
First Line : 1 UNIVERSITY PL
Second Line : WIDENER UNIVERSITY
City : CHESTER
State : PA
Zip : 19013-5700
Country : US
Telephone Number : 610-499-1221
Fax Number : 610-499-4625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2006
Last Update Date : 07/08/2007

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