Provider Demographics
NPI:1639378904
Name:ANTONIO, JUAN M (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:M
Last Name:ANTONIO
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-2011
Mailing Address - Country:US
Mailing Address - Phone:914-949-3545
Mailing Address - Fax:
Practice Address - Street 1:125 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-2011
Practice Address - Country:US
Practice Address - Phone:914-949-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-030916-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical