Healthcare Provider Details

I. General information

NPI: 1801033378
Provider Name (Legal Business Name): ALBERT EUGENE GENTLE JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WARREN PL
TRURO MA
02666-0301
US

IV. Provider business mailing address

PO BOX 301
TRURO MA
02666-0301
US

V. Phone/Fax

Practice location:
  • Phone: 805-729-5007
  • Fax:
Mailing address:
  • Phone: 805-729-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 20101
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102477
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: