Active NPI
Pamela Gibson
- Behavior Analyst
- Philadelphia, PA
National Provider Identifier
1053007039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BH002973
- Practice address
- 2036 N Wanamaker St
Philadelphia, PA 19131-3021 - Phone
- (215) 837-3544
- NPI assigned
- Apr 13, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | BH002973 | PA | Primary |
Addresses
Primary practice location
2036 N Wanamaker St
Philadelphia, PA 19131-3021
Mailing address
833 N Park Rd Ste 200
Wyomissing, PA 19610-1341
Phone (610) 670-8800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BH002973 | PA | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optimum Care Counseling & Wellness Solutions, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Wyomissing, PA
- NPI 1619217395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681344000000",
"number": "1053007039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "833 N PARK RD STE 200",
"city": "WYOMISSING",
"state": "PA",
"postal_code": "196101341",
"telephone_number": "610-670-8800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2036 N WANAMAKER ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191313021",
"telephone_number": "215-837-3544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "PAMELA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-13",
"last_updated": "2023-04-13",
"certification_date": "2023-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "PA",
"license": "BH002973",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.