Provider Demographics
NPI:1508124769
Name:GIBBS, ELIZABETH D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:D
Last Name:GIBBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4 FLETCHER RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-2313
Mailing Address - Country:US
Mailing Address - Phone:603-252-0963
Mailing Address - Fax:
Practice Address - Street 1:4 FLETCHER RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-2313
Practice Address - Country:US
Practice Address - Phone:603-252-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist