Provider Demographics
NPI:1477685774
Name:GIBSON, CAROLYN BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:BETH
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 E SKYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4109
Mailing Address - Country:US
Mailing Address - Phone:559-434-8777
Mailing Address - Fax:
Practice Address - Street 1:5151 N PALM
Practice Address - Street 2:SUITE 950
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2264
Practice Address - Country:US
Practice Address - Phone:559-265-4100
Practice Address - Fax:559-229-4428
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS189371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16647ZMedicare UPIN
CAZZZ16647ZMedicare ID - Type Unspecified