Provider Demographics
NPI:1821364357
Name:GENTRY, CATHERINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:GENTRY
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 1:901 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1270
Mailing Address - Country:US
Mailing Address - Phone:812-525-6861
Mailing Address - Fax:812-346-6252
Practice Address - Street 1:901 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1270
Practice Address - Country:US
Practice Address - Phone:812-525-6861
Practice Address - Fax:317-346-6252
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33006117A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker