MEDICARE: MS. CHARMAINE GENTLES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R061226-1	NY

General Provider Information

NPI Number	:	1558459222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARMAINE GENTLES LCSW

Provider Business Mailing Address
First Line	:	1 VANATA CT
Second Line	:
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-1913
Country	:	US
Telephone Number	:	718-908-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 PLAZA ST E
Second Line	:	SUITE 1C
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4954
Country	:	US
Telephone Number	:	718-908-0360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	10/11/2011

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