Provider Demographics
NPI:1083901557
Name:VINCENT, ANTOINETTE SHALICA (BA)
Entity Type:Individual
Prefix:MISS
First Name:ANTOINETTE
Middle Name:SHALICA
Last Name:VINCENT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 PARK AVE S
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7304
Mailing Address - Country:US
Mailing Address - Phone:212-677-8550
Mailing Address - Fax:212-677-5825
Practice Address - Street 1:257 PARK AVE S
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7304
Practice Address - Country:US
Practice Address - Phone:212-677-8550
Practice Address - Fax:212-677-5825
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor