Provider Demographics
NPI:1932442563
Name:GIBBS, OLIVE S (LMSW)
Entity Type:Individual
Prefix:MS
First Name:OLIVE
Middle Name:S
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3530
Mailing Address - Country:US
Mailing Address - Phone:718-377-7710
Mailing Address - Fax:
Practice Address - Street 1:8325 5TH AVE
Practice Address - Street 2:A1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4560
Practice Address - Country:US
Practice Address - Phone:718-745-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7491455104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker