Provider Demographics
NPI:1144381146
Name:GIBSON, DONNA (PHD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GIBSON
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 1:49 HOWLETT ST
Mailing Address - Street 2:
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-1409
Mailing Address - Country:US
Mailing Address - Phone:978-887-9833
Mailing Address - Fax:978-887-1999
Practice Address - Street 1:49 HOWLETT ST
Practice Address - Street 2:
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-1409
Practice Address - Country:US
Practice Address - Phone:978-887-9833
Practice Address - Fax:978-887-1999
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical