Provider Demographics
NPI:1447326897
Name:GIBSON, SCOTT DAVID (LCSW)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DAVID
Last Name:GIBSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-0919
Mailing Address - Country:US
Mailing Address - Phone:845-325-2989
Mailing Address - Fax:845-943-6469
Practice Address - Street 1:19 DEWITT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-342-4081
Practice Address - Fax:888-801-4331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0346881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032927000Medicare UPIN
NYN7A331Medicare ID - Type Unspecified