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NPI Code Detail

MEDICARE: MRS. CAROLYN L GIBSON LSW

MEDICARE: MRS. CAROLYN L GIBSON LSW
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
1104100000XSocial WorkerS. 0028742OH

General Provider Information

NPI Number : 1760802615
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROLYN L GIBSON LSW
Provider Business Mailing Address
First Line : 2216 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-1828
Country : US
Telephone Number : 513-684-7965
Fax Number : 513-684-7973
Provider Business Practice Location Address
First Line : 2216 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-1828
Country : US
Telephone Number : 513-684-7965
Fax Number : 513-684-7973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2014
Last Update Date : 04/18/2014

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Directions to “ MRS. CAROLYN L GIBSON LSW” Practice Location

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