Active NPI
William Gibson, PHD
- Clinical Psychologist
- Canandaigua, NY
National Provider Identifier
1962439059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 017177
- Practice address
- 400 Fort Hill Ave
Canandaigua, NY 14424-1159 - Phone
- (585) 393-7496
- Fax
- (585) 393-7429
- NPI assigned
- Jun 26, 2006
- Last updated
- Mar 1, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 017177 | NY | Primary |
| Clinical Neuropsychologist | 103G00000X | 017177 | NY |
Addresses
Primary practice location
400 Fort Hill Ave
Canandaigua, NY 14424-1159
Mailing address
400 Fort Hill Ave
Canandaigua, NY 14424-1159
Phone (585) 393-7496
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 423635 | Other | PA | PA BLUE SHILED |
| 651123-01 | Other | PA | BC/BS OF MD CARE FIRST |
| 835851000 | Other | PA | MAGELLAN |
| 50058633 | Other | PA | CAPTIAL BLUE CROSS |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017177 | NY | MD | Clinical Psychologist |
| 759 | LA | MD | Marriage & Family Therapist |
| 00759 | LA | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298937600000",
"number": "1962439059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 FORT HILL AVE",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144241159",
"telephone_number": "585-393-7496",
"fax_number": "585-393-7429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 FORT HILL AVE",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144241159",
"telephone_number": "585-393-7496",
"fax_number": "585-393-7429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "WILLIAM",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-26",
"last_updated": "2011-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "017177",
"primary": true
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "NY",
"license": "017177",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA BLUE SHILED",
"identifier": "423635",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF MD CARE FIRST",
"identifier": "651123-01",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "835851000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPTIAL BLUE CROSS",
"identifier": "50058633",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canandaigua, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.