Provider Demographics
NPI:1265623052
Name:GIBBS, GAIL PETCAVAGE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:PETCAVAGE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6193 BLUE CHURCH ROAD S.
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-9469
Mailing Address - Country:US
Mailing Address - Phone:610-282-2048
Mailing Address - Fax:
Practice Address - Street 1:6193 BLUE CHURCH ROAD S.
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-9469
Practice Address - Country:US
Practice Address - Phone:610-282-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0152391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical