Provider Demographics
NPI:1780634071
Name:GENTILE, JOSEPH G (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:GENTILE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 IMPERIAL CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3220
Mailing Address - Country:US
Mailing Address - Phone:585-467-3324
Mailing Address - Fax:
Practice Address - Street 1:36 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1326
Practice Address - Country:US
Practice Address - Phone:585-454-0431
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036674-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMDH375OtherPREFERRED CARE
NY5712130OtherAETNA
NYR53998Medicare UPIN
NYIA0515Medicare ID - Type Unspecified