Provider Demographics
NPI:1558459222
Name:GENTLES, CHARMAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:
Last Name:GENTLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VANATA CT
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-1913
Mailing Address - Country:US
Mailing Address - Phone:718-908-0360
Mailing Address - Fax:
Practice Address - Street 1:10 PLAZA ST E
Practice Address - Street 2:SUITE 1C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4954
Practice Address - Country:US
Practice Address - Phone:718-908-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR061226-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN532E1Medicare ID - Type Unspecified