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NPI Code Detail

MEDICARE: ABBY GENTILE LCPC

MEDICARE: ABBY GENTILE LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor180012811IL
2101YP2500XProfessional Counselor178012284IL

General Provider Information

NPI Number : 1124521232
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABBY GENTILE LCPC
Provider Business Mailing Address
First Line : 3301 W 111TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2715
Country : US
Telephone Number : 312-469-0486
Fax Number :
Provider Business Practice Location Address
First Line : 3301 W 111TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2715
Country : US
Telephone Number : 312-469-0486
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2018
Last Update Date : 02/14/2020

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