Provider Demographics
NPI:1003428392
Name:GENTILE, DANIELLA LUCILLE (MA)
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:LUCILLE
Last Name:GENTILE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 E WASHINGTON ST STE 212
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-7439
Mailing Address - Country:US
Mailing Address - Phone:602-773-5775
Mailing Address - Fax:
Practice Address - Street 1:5025 E WASHINGTON ST STE 212
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-7439
Practice Address - Country:US
Practice Address - Phone:602-773-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-20-112210106S00000X
AZBEH-001028103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician