Healthcare Provider Details

I. General information

NPI: 1881255065
Provider Name (Legal Business Name): AMANDA GENTILE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 PENN AVE
SCRANTON PA
18503-1211
US

IV. Provider business mailing address

311 PENN AVE
SCRANTON PA
18503-1211
US

V. Phone/Fax

Practice location:
  • Phone: 570-800-1963
  • Fax:
Mailing address:
  • Phone: 570-800-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC011446
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: