Provider Demographics
NPI:1437518503
Name:ANTONIOU, MARIA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ANTONIOU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GATES AVE
Mailing Address - Street 2:APT 15
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2522
Mailing Address - Country:US
Mailing Address - Phone:347-615-8670
Mailing Address - Fax:
Practice Address - Street 1:125 GATES AVE
Practice Address - Street 2:APT 15
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2522
Practice Address - Country:US
Practice Address - Phone:347-615-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001277106H00000X
NJ37FI00179400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist