Provider Demographics
NPI:1003447988
Name:SERTICCHIO, ANTONY (RBT)
Entity Type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:SERTICCHIO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 COLUMBIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1482
Mailing Address - Country:US
Mailing Address - Phone:706-426-0583
Mailing Address - Fax:
Practice Address - Street 1:4106 COLUMBIA RD STE 101
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-1482
Practice Address - Country:US
Practice Address - Phone:706-426-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty