Provider Demographics
NPI:1841950615
Name:GIBILISCO, DANA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:GIBILISCO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SILVER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SHAMONG
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-9302
Mailing Address - Country:US
Mailing Address - Phone:848-459-5943
Mailing Address - Fax:
Practice Address - Street 1:6 SILVER LAKE DR
Practice Address - Street 2:
Practice Address - City:SHAMONG
Practice Address - State:NJ
Practice Address - Zip Code:08088-9302
Practice Address - Country:US
Practice Address - Phone:848-459-5943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00555800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional