Healthcare Provider Details

I. General information

NPI: 1306967138
Provider Name (Legal Business Name): ELLEN GENTNER PHD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W CITRUS ST
ALTAMONTE SPRINGS FL
32714-2502
US

IV. Provider business mailing address

108 W CITRUS ST
ALTAMONTE SPRINGS FL
32714-2502
US

V. Phone/Fax

Practice location:
  • Phone: 407-682-6330
  • Fax: 497-682-5972
Mailing address:
  • Phone: 407-682-6330
  • Fax: 497-682-5972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLEN L GENTNER
Title or Position: OWNER
Credential: PHD
Phone: 407-682-6330