Provider Demographics
NPI:1922606599
Name:GENTILE, IAN BRADLEY (BCBA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:BRADLEY
Last Name:GENTILE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 LANDERBROOK DR STE 310
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4031
Mailing Address - Country:US
Mailing Address - Phone:216-446-2944
Mailing Address - Fax:315-306-3610
Practice Address - Street 1:5885 LANDERBROOK DR STE 310
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4031
Practice Address - Country:US
Practice Address - Phone:216-446-2944
Practice Address - Fax:315-306-3610
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OH00765103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator