Provider Demographics
NPI:1184006702
Name:GIBBS, TASIA
Entity Type:Individual
Prefix:
First Name:TASIA
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LAFAYETTE AVENUE
Mailing Address - Street 2:APT#11B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-7101
Mailing Address - Country:US
Mailing Address - Phone:917-499-1626
Mailing Address - Fax:
Practice Address - Street 1:333 LAFAYETTE AVENUE
Practice Address - Street 2:APT#11B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-7101
Practice Address - Country:US
Practice Address - Phone:917-499-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst