Provider Demographics
NPI:1316586902
Name:ANTAYA, CIARA (BA)
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:
Last Name:ANTAYA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 NEWTON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1838
Mailing Address - Country:US
Mailing Address - Phone:413-355-9488
Mailing Address - Fax:
Practice Address - Street 1:90 CARANDO DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-4205
Practice Address - Country:US
Practice Address - Phone:413-865-6919
Practice Address - Fax:413-865-6902
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician