Provider Demographics
NPI:1851804702
Name:PETRAIA, TONI-ANNE (LBA)
Entity Type:Individual
Prefix:MRS
First Name:TONI-ANNE
Middle Name:
Last Name:PETRAIA
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:TONI-ANNE
Other - Middle Name:
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:68 SKINNER ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1832
Mailing Address - Country:US
Mailing Address - Phone:315-868-4512
Mailing Address - Fax:
Practice Address - Street 1:1449 37TH ST STE 218
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4383
Practice Address - Country:US
Practice Address - Phone:315-868-4512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000504103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst