Provider Demographics
NPI:1861841603
Name:BARNES, ANTANIA M (MS, BSL)
Entity Type:Individual
Prefix:MISS
First Name:ANTANIA
Middle Name:M
Last Name:BARNES
Suffix:
Gender:F
Credentials:MS, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-3595
Mailing Address - Country:US
Mailing Address - Phone:814-746-0617
Mailing Address - Fax:
Practice Address - Street 1:1690 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-3595
Practice Address - Country:US
Practice Address - Phone:814-746-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health