Provider Demographics
NPI:1053437913
Name:GIBSON, JULIE ELISABETH (LCSW-R)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ELISABETH
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14441-0045
Mailing Address - Country:US
Mailing Address - Phone:315-521-9882
Mailing Address - Fax:
Practice Address - Street 1:4120 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14544-9738
Practice Address - Country:US
Practice Address - Phone:585-554-6492
Practice Address - Fax:585-554-3917
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR073585-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical