Healthcare Provider Details

I. General information

NPI: 1558900951
Provider Name (Legal Business Name): BRIANNA NICHOLE GENTILE MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 W 31ST AVE
ANCHORAGE AK
99503-3624
US

IV. Provider business mailing address

230 BELUGA AVE APT C
JBER AK
99505-1043
US

V. Phone/Fax

Practice location:
  • Phone: 907-214-1674
  • Fax:
Mailing address:
  • Phone: 626-644-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number195174
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number191413
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: