Individual
DR. JOHN E. GIBBONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
8 CYPRESS CREEK RD, SEVERNA PARK, MD 21146-4050
(410) 544-8507
Mailing address
488 LYMINGTON RD, SEVERNA PARK, MD 21146-3548
(410) 544-8507
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
02253
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0 - G463 - JE - 62
BLUE CROSS - BLUE SHIELD
MD
01
—
S094 - 0001
GHMSI
MD
Enumeration date
05/23/2007
Last updated
06/16/2019
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