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Individual
WILLIAM GIBSON
Active
Individual
WILLIAM GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
017177
NY
103TC0700X
Clinical Psychologist
Primary
017177
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
423635
PA BLUE SHILED
PA
01
—
50058633
CAPTIAL BLUE CROSS
PA
01
—
651123-01
BC/BS OF MD CARE FIRST
PA
01
—
835851000
MAGELLAN
PA
Enumeration date
06/26/2006
Last updated
03/01/2011
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