Provider Demographics
NPI:1861652422
Name:ANTONIO, TRICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name: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 1:5825 SWORDFISH CT
Mailing Address - Street 2:UNIT A
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-6296
Mailing Address - Country:US
Mailing Address - Phone:954-366-9842
Mailing Address - Fax:
Practice Address - Street 1:11820 MIRAMAR PKWY STE 224
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5818
Practice Address - Country:US
Practice Address - Phone:954-366-9842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 92601041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical