Provider Demographics
NPI:1093860934
Name:GIBERSON, JEANNE E (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:E
Last Name:GIBERSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:RIDERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21139-0004
Mailing Address - Country:US
Mailing Address - Phone:443-928-4068
Mailing Address - Fax:
Practice Address - Street 1:305 WASHINGTON AVE STE 500
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4747
Practice Address - Country:US
Practice Address - Phone:443-928-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1093860934OtherUBH
2132142OtherMAMSI
MD646122-01OtherBLUE CROSS BLUE SHIELD
MD7009756OtherAETNA
MD5033038OtherAPS
MDH2407283OtherCIGNA
MD408034300OtherMEDICAL ASSISTANCE
MD808225000OtherMAGELLAN
J648-0004OtherBLUE CROSS BLUE SHIELD
MD255222OtherCOMPSYCH
MD548825OtherVALUE OPTIONS