Provider Demographics
NPI:1881289437
Name:GIBSON, REBECCA ELLEN (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ELLEN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 YORK ROAD, SUITE 800
Mailing Address - Street 2:#1028
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6348
Mailing Address - Country:US
Mailing Address - Phone:443-212-8137
Mailing Address - Fax:
Practice Address - Street 1:1301 YORK ROAD, SUITE 800
Practice Address - Street 2:#1028
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6348
Practice Address - Country:US
Practice Address - Phone:443-212-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1257521041C0700X
MD249001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical