Provider Demographics
NPI:1679770259
Name:ANTOLICK, NANCY (MA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ANTOLICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOLLYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2616
Mailing Address - Country:US
Mailing Address - Phone:732-255-8607
Mailing Address - Fax:732-255-8607
Practice Address - Street 1:554 COMMONS WAY
Practice Address - Street 2:BUILDING E
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6432
Practice Address - Country:US
Practice Address - Phone:732-255-8607
Practice Address - Fax:732-255-8607
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC00629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional