Provider Demographics
NPI:1760802615
Name:GIBSON, CAROLYN L (LSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1828
Mailing Address - Country:US
Mailing Address - Phone:513-684-7965
Mailing Address - Fax:513-684-7973
Practice Address - Street 1:2216 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1828
Practice Address - Country:US
Practice Address - Phone:513-684-7965
Practice Address - Fax:513-684-7973
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 0028742104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker