Healthcare Provider Details

I. General information

NPI: 1225253321
Provider Name (Legal Business Name): STEVEN RICHARD GENTILE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

PO BOX 62600 DEPT 1420
NEW ORLEANS LA
70162-2600
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-7272
  • Fax: 504-896-7373
Mailing address:
  • Phone: 504-896-7272
  • Fax: 504-896-7273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number924
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number924
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: