MEDICARE: MR. BRIAN MATTHEW GENTILE LMHC, CRC

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	101YM0800X	Mental Health Counselor	001555	NY

General Provider Information

NPI Number	:	1972164184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN MATTHEW GENTILE LMHC, CRC

Provider Business Mailing Address
First Line	:	21 CENTERVIEW DR
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-1916
Country	:	US
Telephone Number	:	518-461-9780
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 CENTURY HILL DR
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2128
Country	:	US
Telephone Number	:	518-461-9780
Fax Number	:

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

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	06/27/2019

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