Provider Demographics
NPI:1760930978
Name:ANTENUCCI, ANMARIE JEAN (MSW,LSW,OSW-C)
Entity Type:Individual
Prefix:MS
First Name:ANMARIE
Middle Name:JEAN
Last Name:ANTENUCCI
Suffix:
Gender:F
Credentials:MSW,LSW,OSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 N CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2184
Mailing Address - Country:US
Mailing Address - Phone:330-723-7977
Mailing Address - Fax:330-725-5177
Practice Address - Street 1:843 N CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2184
Practice Address - Country:US
Practice Address - Phone:330-723-7977
Practice Address - Fax:330-725-5177
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00184341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical