Provider Demographics
NPI:1376015883
Name:GIBBONS, JENNIFER ELIZABETH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7000 GREAT MEADOW RD FL 2
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4090
Mailing Address - Country:US
Mailing Address - Phone:781-234-9671
Mailing Address - Fax:781-234-9644
Practice Address - Street 1:7000 GREAT MEADOW RD FL 2
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4090
Practice Address - Country:US
Practice Address - Phone:781-234-9671
Practice Address - Fax:781-234-9644
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1193181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical