Provider Demographics
NPI:1588430482
Name:GENTRY, ALYSSA S
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:S
Last Name:GENTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LILAC CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3629
Mailing Address - Country:US
Mailing Address - Phone:925-914-0527
Mailing Address - Fax:
Practice Address - Street 1:4023 KENNETT PIKE # 988
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-2018
Practice Address - Country:US
Practice Address - Phone:484-577-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician