Provider Demographics
NPI:1609056332
Name:ANTONACCI, BRENDA (MS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:ANTONACCI
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BERRY ST
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2320
Mailing Address - Country:US
Mailing Address - Phone:570-407-9810
Mailing Address - Fax:
Practice Address - Street 1:206 BERRY ST
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2320
Practice Address - Country:US
Practice Address - Phone:570-407-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003044101YP2500X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional