Provider Demographics
NPI:1952049835
Name:GIBSON, CASSANDRA CRAWFORD (PHD, LCSW, LCADC)
Entity Type:Individual
Prefix:PROF
First Name:CASSANDRA
Middle Name:CRAWFORD
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHD, LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 RIVER RD UNIT 81
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-2205
Mailing Address - Country:US
Mailing Address - Phone:215-932-0555
Mailing Address - Fax:
Practice Address - Street 1:2000 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1104
Practice Address - Country:US
Practice Address - Phone:215-932-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00304400101YA0400X
NJ44SC055454001041C0700X
PACW0164721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)