Provider Demographics
NPI:1659720670
Name:GIBBS, EMILY (LSW, MSSA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LSW, MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11843 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1779
Mailing Address - Country:US
Mailing Address - Phone:412-463-5674
Mailing Address - Fax:
Practice Address - Street 1:4600 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4371
Practice Address - Country:US
Practice Address - Phone:216-431-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600284104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker