Provider Demographics
NPI:1497129803
Name:ANTINE, AVRAHAM (LCSW)
Entity Type:Individual
Prefix:
First Name:AVRAHAM
Middle Name:
Last Name:ANTINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SE 4TH AVE
Mailing Address - Street 2:UNIT 104-105
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-4574
Mailing Address - Country:US
Mailing Address - Phone:561-777-0226
Mailing Address - Fax:
Practice Address - Street 1:85 SE 4TH AVE
Practice Address - Street 2:UNIT 104-105
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3348
Practice Address - Country:US
Practice Address - Phone:561-777-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical