MEDICARE: GELISSA GIBSON

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	104100000X	Social Worker	32222	MD

General Provider Information

NPI Number	:	1912831454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GELISSA GIBSON

Provider Business Mailing Address
First Line	:	2418 BRIDGEHAMPTON DR APT I
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-7344
Country	:	US
Telephone Number	:	862-255-0618
Fax Number	:

Provider Business Practice Location Address
First Line	:	2418 BRIDGEHAMPTON DR APT I
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-7344
Country	:	US
Telephone Number	:	862-255-0618
Fax Number	:

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

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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Directions to “ GELISSA GIBSON ” Practice Location

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