Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 014201-1 | NY |
Y | 103TC0700X | Clinical Psychologist | 014201-1 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 014201-1 | NY |
NPI | 1043435720 |
---|---|
Provider Name | Leslie A. Gibson |
First Address | Ardsley, NY 10502-2143 |
Second Address | Ardsley, NY 10502-2143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 04/06/2021 |