Provider Demographics
NPI:1821716143
Name:PAPESH, ANTOINETTE GABRIELLE
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:GABRIELLE
Last Name:PAPESH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W HOSPITALITY LN STE 11092408
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3243
Mailing Address - Country:US
Mailing Address - Phone:909-332-7707
Mailing Address - Fax:
Practice Address - Street 1:325 W HOSPITALITY LN STE 11092408
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3243
Practice Address - Country:US
Practice Address - Phone:909-332-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA15532101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health