Provider Demographics
NPI:1407907462
Name:ANTOINE, MARIE BERTHONIA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:BERTHONIA
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-1127
Mailing Address - Country:US
Mailing Address - Phone:617-265-0628
Mailing Address - Fax:671-265-4134
Practice Address - Street 1:745 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1941
Practice Address - Country:US
Practice Address - Phone:617-364-3035
Practice Address - Fax:617-364-3059
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health