Provider Demographics
NPI:1023221611
Name:GIBBONS, ERIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROCKLAND ST
Mailing Address - Street 2:APT 7
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-6309
Mailing Address - Country:US
Mailing Address - Phone:617-416-9054
Mailing Address - Fax:
Practice Address - Street 1:55 CHAPEL ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1060
Practice Address - Country:US
Practice Address - Phone:617-658-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9289103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist