Provider Demographics
NPI:1376356782
Name:MICKEY, ANTHONY LAMONT (RBT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LAMONT
Last Name:MICKEY
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6211 S HIGHLAND DR # 4032
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2125
Mailing Address - Country:US
Mailing Address - Phone:804-928-1734
Mailing Address - Fax:
Practice Address - Street 1:945 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1604
Practice Address - Country:US
Practice Address - Phone:385-354-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UTBACB962783106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician