Provider Demographics
NPI:1922154442
Name:GIBSON, RONALD ANTONY JR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ANTONY
Last Name:GIBSON
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:37 GIDDINGS AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3701
Mailing Address - Country:US
Mailing Address - Phone:860-398-0390
Mailing Address - Fax:
Practice Address - Street 1:24 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2335
Practice Address - Country:US
Practice Address - Phone:860-398-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist