Provider Demographics
NPI:1750767323
Name:ANTONOPOULOS, CHRISOULA MARIE (LMSW)
Entity type:Individual
Prefix:MS
First Name:CHRISOULA
Middle Name:MARIE
Last Name:ANTONOPOULOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2704
Mailing Address - Country:US
Mailing Address - Phone:718-850-7099
Mailing Address - Fax:718-850-9361
Practice Address - Street 1:10501 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2704
Practice Address - Country:US
Practice Address - Phone:718-850-7099
Practice Address - Fax:718-850-9361
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088276104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker