Provider Demographics
NPI:1629588629
Name:GIBNEY, YULIA (WHNP- BC, PMHNP- BC)
Entity Type:Individual
Prefix:MRS
First Name:YULIA
Middle Name:
Last Name:GIBNEY
Suffix:
Gender:F
Credentials:WHNP- BC, PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2702
Mailing Address - Country:US
Mailing Address - Phone:781-244-0115
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2702
Practice Address - Country:US
Practice Address - Phone:781-244-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2280839363LW0102X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2023124341OtherANCC PMHNP CERTIFICATION
MARN2280839OtherMASSACHUSETTS NP LICENSE
MA104409204OtherNCC CERTIFICATION