Provider Demographics
NPI:1558900951
Name:GENTILE, BRIANNA NICHOLE (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NICHOLE
Last Name:GENTILE
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BELUGA AVE APT C
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505-1043
Mailing Address - Country:US
Mailing Address - Phone:626-644-6949
Mailing Address - Fax:
Practice Address - Street 1:1413 W 31ST AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3624
Practice Address - Country:US
Practice Address - Phone:907-214-1674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK191413106E00000X
106S00000X
AK195174103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician