Provider Demographics
NPI:1104092766
Name:GENTILE, JULAINE FAYE (CHEMICAL DEPENDENCY)
Entity type:Individual
Prefix:
First Name:JULAINE
Middle Name:FAYE
Last Name:GENTILE
Suffix:
Gender:F
Credentials:CHEMICAL DEPENDENCY
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 4TH ST
Mailing Address - Street 2:EAST CENTRAL MHICD CENTER INC
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006
Mailing Address - Country:US
Mailing Address - Phone:605-697-2850
Mailing Address - Fax:605-697-2874
Practice Address - Street 1:211 4TH ST
Practice Address - Street 2:EAST CENTRAL MHICD CENTER INC
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006
Practice Address - Country:US
Practice Address - Phone:605-697-2850
Practice Address - Fax:605-697-2874
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200060Medicaid