Provider Demographics
NPI:1801622402
Name:MACGIBBON PSYCHOTHERAPY BATTLE YOUR DEMONS
Entity type:Organization
Organization Name:MACGIBBON PSYCHOTHERAPY BATTLE YOUR DEMONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACGIBBON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-220-0752
Mailing Address - Street 1:583 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3846
Mailing Address - Country:US
Mailing Address - Phone:973-220-0752
Mailing Address - Fax:
Practice Address - Street 1:583 GROVE ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3846
Practice Address - Country:US
Practice Address - Phone:973-220-0752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty