Provider Demographics
NPI:1568755205
Name:GENTILI, NICOLE MARIE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:GENTILI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 FOXBRIDGE VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2215
Mailing Address - Country:US
Mailing Address - Phone:203-654-6032
Mailing Address - Fax:
Practice Address - Street 1:23 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2315
Practice Address - Country:US
Practice Address - Phone:203-245-5070
Practice Address - Fax:203-245-5076
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0062121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical