Provider Demographics
NPI:1164074860
Name:GIBSON, RENEE ARNETTE (LMSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ARNETTE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 ELDRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-5621
Mailing Address - Country:US
Mailing Address - Phone:718-594-7885
Mailing Address - Fax:
Practice Address - Street 1:94 ELDRIDGE AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-5621
Practice Address - Country:US
Practice Address - Phone:718-594-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083008104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker