Provider Demographics
NPI:1710761655
Name:ANTONOW, CHERI (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:CHERI
Middle Name:
Last Name:ANTONOW
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 INDUSTRIAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1742
Mailing Address - Country:US
Mailing Address - Phone:734-786-2626
Mailing Address - Fax:
Practice Address - Street 1:1235 INDUSTRIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1742
Practice Address - Country:US
Practice Address - Phone:734-730-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511153881041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical