Provider Demographics
NPI:1356461511
Name:GIBBONS, JOHN J (PHD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MARION ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2316
Mailing Address - Country:US
Mailing Address - Phone:570-904-3634
Mailing Address - Fax:
Practice Address - Street 1:808 SPRING ST
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641-1114
Practice Address - Country:US
Practice Address - Phone:570-904-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical