Provider Demographics
NPI:1770644940
Name:GENTILE, TERESA J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:J
Last Name:GENTILE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BLUE HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-0123
Mailing Address - Country:US
Mailing Address - Phone:413-528-0213
Mailing Address - Fax:
Practice Address - Street 1:401 STOCKBRIDGE RD.
Practice Address - Street 2:
Practice Address - City:GT.BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:413-274-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1101261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP2267501OtherMEDICARE PTAN
MAGEP22675Medicare ID - Type UnspecifiedPROVIDER NUMBER