Provider Demographics
NPI:1851119960
Name:GENTILE, LAWRENCE P JR
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:P
Last Name:GENTILE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 E INDIANOLA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-2309
Mailing Address - Country:US
Mailing Address - Phone:234-275-0675
Mailing Address - Fax:
Practice Address - Street 1:5385 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2246
Practice Address - Country:US
Practice Address - Phone:234-275-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker