Provider Demographics
NPI:1356717615
Name:MARCANTONIO, ANNALISA HOPE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANNALISA
Middle Name:HOPE
Last Name:MARCANTONIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNALISA
Other - Middle Name:HOPE
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3249 EDINBURG CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-5631
Mailing Address - Country:US
Mailing Address - Phone:850-823-9585
Mailing Address - Fax:
Practice Address - Street 1:4401 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-2842
Practice Address - Country:US
Practice Address - Phone:850-823-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW227731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty