Provider Demographics
NPI:1003447988
Name:SERTICCHIO, ANTONY (RBT)
Entity type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:SERTICCHIO
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E GREGORY LN
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-5168
Mailing Address - Country:US
Mailing Address - Phone:509-599-3138
Mailing Address - Fax:
Practice Address - Street 1:702 E FRONT AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4012
Practice Address - Country:US
Practice Address - Phone:509-599-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty