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General NPI Number Information
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NPI Number | 1700932472
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Entity Type | Individual
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Provider Name | MARY C GENTILE L.C.S.W.-C
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8028 RITCHIE HWY 310
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City | PASADENA
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State | MD
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Zip | 21122-1075
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Country | US
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Telephone | 410-768-3361
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Fax |
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Provider Business Mailing Address
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Address Line | 7004 EVERGREEN DR
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City | WALDORF
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State | MD
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Zip | 20601-3332
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Country | US
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Telephone | 301-638-9294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 05234
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License Number State | MD
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