Provider Demographics
NPI:1295034957
Name:ANTONIOU, DEBORAH (EDS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:ANTONIOU
Suffix:
Gender:F
Credentials:EDS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16414 LAKE CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2637
Mailing Address - Country:US
Mailing Address - Phone:917-328-3623
Mailing Address - Fax:
Practice Address - Street 1:16414 LAKE CHURCH DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2637
Practice Address - Country:US
Practice Address - Phone:917-328-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0-02-0492103K00000X
NY222Q00000X
FL1-14-15093103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist