Mark J. Gibson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27742 Issued in CA

Practice address

18 Bryson Dr
Sutter Creek, CA 95685-4118

Phone

(530) 210-2285

Fax

(530) 492-0902

NPI assigned

Sep 28, 2011

Last updated

Dec 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Oct 1, 2016 through Oct 1, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Livity Treatment Center

  • Clinical Social Worker
  • Carmichael, CA
  • NPI 1790115871
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1215211008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 BRYSON DR",
            "city": "SUTTER CREEK",
            "state": "CA",
            "postal_code": "956854118",
            "telephone_number": "530-210-2285",
            "fax_number": "530-492-0902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 BRYSON DR",
            "city": "SUTTER CREEK",
            "state": "CA",
            "postal_code": "956854118",
            "telephone_number": "530-210-2285",
            "fax_number": "530-492-0902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "MARK",
        "middle_name": "J.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-28",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "27742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Fillmore
• Janeen Flanagan, SUDRC 9707
• James Foley
• Kelli G Garcia, O.D.
• Tamara Lynn Garner
• Tim Glass, APCC
• Anthony Godsey, M.A.
• Elayne Gwynne
• Brett Haight
• Harbor Lights Transportation, Inc.

• Clinical Social Worker in Sutter Creek, CA
• Providers in Sutter Creek, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.