Provider Demographics
NPI:1952511131
Name:GIBILISCO, JOSEPH ANGELO (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANGELO
Last Name:GIBILISCO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 OSPREY POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-2591
Mailing Address - Country:US
Mailing Address - Phone:863-258-4177
Mailing Address - Fax:
Practice Address - Street 1:3815 OSPREY POINTE CIR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-2591
Practice Address - Country:US
Practice Address - Phone:863-258-4177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist