Provider Demographics
NPI:1811971955
Name:GENTILE, JUDITH (MSW)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:GENTILE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 AVENUE T
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4916
Mailing Address - Country:US
Mailing Address - Phone:718-998-9563
Mailing Address - Fax:718-376-9115
Practice Address - Street 1:3601 AVENUE T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4916
Practice Address - Country:US
Practice Address - Phone:718-998-9563
Practice Address - Fax:718-376-9115
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0366771104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN59901Medicare ID - Type Unspecified