Tiffany Jane Gentile, MS LMHC CEDS NCC CAS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

005109-1 Issued in NY

Practice address

188 S 3Rd St
Fulton, NY 13069-1801

Phone

(315) 591-7007

NPI assigned

Aug 18, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tiffany Jane Burdick Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513814400000",
    "number": "1104131804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 SOUTH 3RD STREET",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "13069",
            "telephone_number": "315-207-5435",
            "fax_number": "315-410-5544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 S 3RD ST",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130691801",
            "telephone_number": "315-591-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENTILE",
        "first_name": "TIFFANY",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "MS LMHC CEDS NCC CAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-18",
        "last_updated": "2017-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "005109-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "BURDICK",
            "middle_name": "JANE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Fulton, NY
• Providers in Fulton, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.