Provider Demographics
NPI:1861487662
Name:RAITEN-D'ANTONIO, TONI ELLEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:ELLEN
Last Name:RAITEN-D'ANTONIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ARLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2202
Mailing Address - Country:US
Mailing Address - Phone:631-476-3073
Mailing Address - Fax:
Practice Address - Street 1:1 ARLINGTON CT
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2202
Practice Address - Country:US
Practice Address - Phone:631-476-3073
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRP039058-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health