Provider Demographics
NPI:1295801900
Name:GIBBES, BERTRAM ST CYR LINARD (PHD PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:ST CYR LINARD
Last Name:GIBBES
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:481A KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3607
Mailing Address - Country:US
Mailing Address - Phone:401-782-1667
Mailing Address - Fax:401-782-1669
Practice Address - Street 1:481A KINGSTOWN RD
Practice Address - Street 2:SUITE D4
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3607
Practice Address - Country:US
Practice Address - Phone:401-782-1667
Practice Address - Fax:401-782-1669
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI511103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI68900-5994Medicare PIN