Provider Demographics
NPI:1649215872
Name:ANTANI, RITA U (PSYD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:U
Last Name:ANTANI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70092
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-0002
Mailing Address - Country:US
Mailing Address - Phone:248-931-3176
Mailing Address - Fax:888-909-6848
Practice Address - Street 1:2820 CROOKS RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3620
Practice Address - Country:US
Practice Address - Phone:248-931-3176
Practice Address - Fax:248-289-6540
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008402103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F332027OtherBLUE CROSS MICHIGAN
MI680F332027OtherBLUE CROSS MICHIGAN