Provider Demographics
NPI:1316553415
Name:ANTOINE, BEATRICE (LCSW)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 SCHOOL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-4547
Mailing Address - Country:US
Mailing Address - Phone:781-985-2080
Mailing Address - Fax:
Practice Address - Street 1:69 ALLEGHANY ST
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-3336
Practice Address - Country:US
Practice Address - Phone:857-276-8959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical