Provider Demographics
NPI:1740485549
Name:GIBSON, DONNA SUE (RN, LMHC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:SUE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RN, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NASH HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAYDENVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01039-9720
Mailing Address - Country:US
Mailing Address - Phone:413-268-7421
Mailing Address - Fax:
Practice Address - Street 1:40 BOBALA RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-9632
Practice Address - Country:US
Practice Address - Phone:413-536-5473
Practice Address - Fax:413-532-8205
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3555101YM0800X
MA89263163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered163W00000XNursing Service ProvidersRegistered Nurse