Provider Demographics
NPI:1174676597
Name:MAXON, ANTONIA BRANCIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:BRANCIA
Last Name:MAXON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06247-1320
Mailing Address - Country:US
Mailing Address - Phone:860-455-1404
Mailing Address - Fax:860-455-1396
Practice Address - Street 1:354 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06247-1320
Practice Address - Country:US
Practice Address - Phone:860-455-1404
Practice Address - Fax:860-455-1396
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT57231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist