Provider Demographics
NPI:1861799694
Name:GIBSON, DEBRA N (LCSW, LCADC, MHS)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:N
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LCSW, LCADC, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 MORRIS AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4841
Mailing Address - Country:US
Mailing Address - Phone:908-349-8760
Mailing Address - Fax:908-349-8092
Practice Address - Street 1:2810 MORRIS AVE STE 209
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4841
Practice Address - Country:US
Practice Address - Phone:908-349-8760
Practice Address - Fax:908-349-8092
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00154800101YA0400X
NJS-4343101YM0800X
NJ44SC010151001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health