Healthcare Provider Details

I. General information

NPI: 1619769114
Provider Name (Legal Business Name): MARIA GENTILE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 S MICHIGAN AVE STE 900
CHICAGO IL
60604-4393
US

IV. Provider business mailing address

447 SUTTER ST STE 405
SAN FRANCISCO CA
94108-4618
US

V. Phone/Fax

Practice location:
  • Phone: 415-992-6155
  • Fax: 650-360-6913
Mailing address:
  • Phone: 415-992-6155
  • Fax: 650-360-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.116357
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: