Provider Demographics
NPI:1972164184
Name:GENTILE, BRIAN MATTHEW (LMHC, CRC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MATTHEW
Last Name:GENTILE
Suffix:
Gender:M
Credentials:LMHC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CENTERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1916
Mailing Address - Country:US
Mailing Address - Phone:518-461-9780
Mailing Address - Fax:
Practice Address - Street 1:26 CENTURY HILL DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2128
Practice Address - Country:US
Practice Address - Phone:518-461-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001555101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health