Provider Demographics
NPI:1639209661
Name:GIBSON, KATHRYN ANN (MASTER OF ARTS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MASTER OF ARTS
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:SOKALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LCADC, ACS CCTP
Mailing Address - Street 1:1229 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-2541
Mailing Address - Country:US
Mailing Address - Phone:609-646-1542
Mailing Address - Fax:
Practice Address - Street 1:899 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:VILLAS
Practice Address - State:NJ
Practice Address - Zip Code:08251-2780
Practice Address - Country:US
Practice Address - Phone:609-886-8666
Practice Address - Fax:609-886-9666
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NJ37LC00167300101YA0400X
NJ37PC00401400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)