Provider Demographics
NPI:1679815070
Name:GIBBONE, ANGELA (SPECIAL EDUCATOR MA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GIBBONE
Suffix:
Gender:F
Credentials:SPECIAL EDUCATOR MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 ARCHER ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4803
Mailing Address - Country:US
Mailing Address - Phone:516-582-7615
Mailing Address - Fax:
Practice Address - Street 1:416 ARCHER ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4803
Practice Address - Country:US
Practice Address - Phone:516-582-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-23
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267137891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional