Provider Demographics
NPI:1740648286
Name:KATHRYN L. MCGIBBON, LCSW, LLC
Entity type:Organization
Organization Name:KATHRYN L. MCGIBBON, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGIBBON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:475-434-8744
Mailing Address - Street 1:54 BUELL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-4311
Mailing Address - Country:US
Mailing Address - Phone:475-434-8744
Mailing Address - Fax:
Practice Address - Street 1:54 BUELL ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-4311
Practice Address - Country:US
Practice Address - Phone:475-434-8744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0087341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty