Provider Demographics
NPI:1942672506
Name:GENTILE, ELIZABETH (MS BCBA LABA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GENTILE
Suffix:
Gender:F
Credentials:MS BCBA LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 NEWBURY ST
Mailing Address - Street 2:STE 400
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:73 NEWBURY ST
Practice Address - Street 2:STE 400
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3042
Practice Address - Country:US
Practice Address - Phone:617-839-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-13-14729103K00000X
MA543103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst