Provider Demographics
NPI:1912440934
Name:GIBBS, KASSANDRA (LCSW 93147)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LCSW 93147
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4842
Mailing Address - Country:US
Mailing Address - Phone:530-524-1101
Mailing Address - Fax:
Practice Address - Street 1:47 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4842
Practice Address - Country:US
Practice Address - Phone:530-524-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA931471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical