Provider Demographics
NPI:1245543453
Name:GIBSON, BEVERLY M (LCADC, CSW)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:M
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LCADC, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 DUNMORE AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1974
Mailing Address - Country:US
Mailing Address - Phone:609-577-9714
Mailing Address - Fax:609-671-0015
Practice Address - Street 1:68 DUNMORE AVNEUE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618
Practice Address - Country:US
Practice Address - Phone:609-577-9714
Practice Address - Fax:608-671-1500
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW00330700101Y00000X
NJ37LC00032400101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SW00330700OtherCSW
NJ37LC00032400OtherLCADC, CSW