Provider Demographics
NPI:1497245302
Name:GIANTONIO, SUZAN
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:GIANTONIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ESTHER CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2946
Mailing Address - Country:US
Mailing Address - Phone:732-523-1245
Mailing Address - Fax:
Practice Address - Street 1:2 ESTHER CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2946
Practice Address - Country:US
Practice Address - Phone:732-523-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty