Provider Demographics
NPI:1821262023
Name:GIBSON, DIANE K (MSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:K
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W END AVE
Mailing Address - Street 2:3G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3547
Mailing Address - Country:US
Mailing Address - Phone:212-662-1986
Mailing Address - Fax:
Practice Address - Street 1:900 W END AVE
Practice Address - Street 2:3G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3547
Practice Address - Country:US
Practice Address - Phone:212-662-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR030024-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical