Provider Demographics
NPI:1457303489
Name:PACKER GERBER, JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:PACKER GERBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:PACKER
Other - Last Name:GERBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:102 RAINBOW DR
Mailing Address - Street 2:APT 218
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-1002
Mailing Address - Country:US
Mailing Address - Phone:845-541-2715
Mailing Address - Fax:361-788-2599
Practice Address - Street 1:4018 LARK DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4994
Practice Address - Country:US
Practice Address - Phone:845-541-2715
Practice Address - Fax:845-564-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0417381041C0700X
FL98941041C0700X
TX540011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN8M381Medicare ID - Type Unspecified