Healthcare Provider Details

I. General information

NPI: 1609359074
Provider Name (Legal Business Name): LENTY GORDON M.A., C.A.G.S, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MARCONI ST
NORTH PROVIDENCE RI
02904-3901
US

IV. Provider business mailing address

40 MARCONI ST
NORTH PROVIDENCE RI
02904-3901
US

V. Phone/Fax

Practice location:
  • Phone: 401-556-2688
  • Fax:
Mailing address:
  • Phone: 401-556-2688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01218
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: