Basic Information
| Provider Information | |||||||||
| NPI: | 1386209195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIOS-GIBSON | ||||||||
| FirstName: | JESENIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 ESSEX ST | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122062019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184756180 | ||||||||
| FaxNumber: | 5184756199 | ||||||||
| Practice Location | |||||||||
| Address1: | 676 CLINTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122062216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184756000 | ||||||||
| FaxNumber: | 5184756704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2019 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | 106325 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | School |
ID Information
| ID | Type | State | Issuer | Description | 106325 | 01 | NY | LMSW LICENSE NUMBER | OTHER |