Provider Demographics
NPI:1093478695
Name:FERMAN, ANTONIA ROXANE (BCBA-D, LBA(CT))
Entity Type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:ROXANE
Last Name:FERMAN
Suffix:
Gender:F
Credentials:BCBA-D, LBA(CT)
Other - Prefix:DR
Other - First Name:ANTONIA
Other - Middle Name:ROXANE
Other - Last Name:GIANNAKAKOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA-D, LBA(CT)
Mailing Address - Street 1:72 TWIN BROOK TER
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1808
Mailing Address - Country:US
Mailing Address - Phone:203-885-6409
Mailing Address - Fax:
Practice Address - Street 1:59 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4405
Practice Address - Country:US
Practice Address - Phone:203-210-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst