Provider Demographics
NPI:1841987492
Name:GIBBS, KIFFANY LYNN (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:KIFFANY
Middle Name:LYNN
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DENTON RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-6404
Mailing Address - Country:US
Mailing Address - Phone:415-652-2696
Mailing Address - Fax:
Practice Address - Street 1:11 DENTON RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-6404
Practice Address - Country:US
Practice Address - Phone:415-652-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1041C0700X
CALCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical