Provider Demographics
NPI:1033763198
Name:GIBSON, VIVIEN (PMHNP)
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-3926
Mailing Address - Country:US
Mailing Address - Phone:845-943-8798
Mailing Address - Fax:
Practice Address - Street 1:121 RED SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2810
Practice Address - Country:US
Practice Address - Phone:845-831-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402712363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health