Provider Demographics
NPI:1093780348
Name:GENTILE, MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:GENTILE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 S COOK ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4537
Mailing Address - Country:US
Mailing Address - Phone:509-487-6337
Mailing Address - Fax:509-443-7071
Practice Address - Street 1:5915 S REGAL ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-6026
Practice Address - Country:US
Practice Address - Phone:509-487-6337
Practice Address - Fax:509-443-7071
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG319000091Medicare ID - Type Unspecified