Provider Demographics
NPI:1790040012
Name:ANTONELLI, CAROLINE DALY (MA, SPEC ED)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:DALY
Last Name:ANTONELLI
Suffix:
Gender:F
Credentials:MA, SPEC ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 HOUSES CORNER RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3409
Mailing Address - Country:US
Mailing Address - Phone:201-819-7922
Mailing Address - Fax:
Practice Address - Street 1:151 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3851
Practice Address - Country:US
Practice Address - Phone:845-638-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist