Provider Demographics
NPI:1326634106
Name:KENTILE, ADAM (INTERN)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:KENTILE
Suffix:
Gender:M
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3191
Mailing Address - Country:US
Mailing Address - Phone:607-753-0234
Mailing Address - Fax:
Practice Address - Street 1:156 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2611
Practice Address - Country:US
Practice Address - Phone:607-729-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor