Provider Demographics
NPI:1407408628
Name:CHROMAN, ANTOINETTE (EDS)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:CHROMAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 LAGUNA ST APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1315
Mailing Address - Country:US
Mailing Address - Phone:619-929-6686
Mailing Address - Fax:
Practice Address - Street 1:7 W FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3189
Practice Address - Country:US
Practice Address - Phone:805-308-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-7879103K00000X
CA3551103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst