Provider Demographics
NPI:1407227747
Name:ANTONITION, DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:ANTONITION
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 1:354 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04681-3217
Mailing Address - Country:US
Mailing Address - Phone:207-367-2311
Mailing Address - Fax:207-367-2805
Practice Address - Street 1:354 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:STONINGTON
Practice Address - State:ME
Practice Address - Zip Code:04681-3217
Practice Address - Country:US
Practice Address - Phone:207-367-2311
Practice Address - Fax:207-367-2805
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC167241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1407227747Medicaid