Provider Demographics
NPI:1295852507
Name:ANTONOW, DOROTHY (LMSW,ACSW,CACI)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:ANTONOW
Suffix:
Gender:F
Credentials:LMSW,ACSW,CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3556 TERHUNE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5320
Mailing Address - Country:US
Mailing Address - Phone:734-973-7058
Mailing Address - Fax:
Practice Address - Street 1:2008 HOGBACK RD
Practice Address - Street 2:SUITE 8
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9768
Practice Address - Country:US
Practice Address - Phone:734-786-4900
Practice Address - Fax:734-786-8051
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010814771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical