Active NPI
Renee Victoria Gibson, LCAT
- Art Therapist
- Plymouth, MA
National Provider Identifier
1154510493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Art Therapist
- License
- 000791-1
- Practice address
- 50 Aldrin Rd
Plymouth, MA 02360-4827 - Phone
- (508) 830-0000
- NPI assigned
- Oct 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Art Therapist | 221700000X | 000791-1 | NY | Primary |
Addresses
Primary practice location
50 Aldrin Rd
Plymouth, MA 02360-4827
Mailing address
178 Hyde Park Ave
Apt. 2
Jamaica Plain, MA 02130-4133
Phone (518) 860-6842
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 |
|---|---|---|---|
| 000791-1 | NY | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280966400000",
"number": "1154510493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "178 HYDE PARK AVE",
"address_2": "APT. 2",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021304133",
"telephone_number": "518-860-6842"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 ALDRIN RD",
"city": "PLYMOUTH",
"state": "MA",
"postal_code": "023604827",
"telephone_number": "508-830-0000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "RENEE",
"middle_name": "VICTORIA",
"name_prefix": "Ms.",
"credential": "LCAT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-23",
"last_updated": "2010-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "221700000X",
"taxonomy_group": "",
"desc": "Art Therapist",
"state": "NY",
"license": "000791-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.