Provider Demographics
NPI:1003194465
Name:GIBBONS, BRIDGET (MA)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MA
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Other - Credentials:
Mailing Address - Street 1:707 N BROADWAY
Mailing Address - Street 2:KENNEDY KRIEGER INSTITUTE- BEHAVIORAL PSYCHOLOGY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1832
Mailing Address - Country:US
Mailing Address - Phone:443-923-9532
Mailing Address - Fax:443-923-2835
Practice Address - Street 1:707 N BROADWAY
Practice Address - Street 2:KENNEDY KRIEGER INSTITUTE- BEHAVIORAL PSYCHOLOGY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1832
Practice Address - Country:US
Practice Address - Phone:443-923-9532
Practice Address - Fax:443-923-2835
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst