Provider Demographics
NPI:1881236263
Name:ANTONIONO, CHRISTIN NIKOL (BCBA)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:NIKOL
Last Name:ANTONIONO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 NIMITZ AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6338
Mailing Address - Country:US
Mailing Address - Phone:814-880-0786
Mailing Address - Fax:
Practice Address - Street 1:330 NIMITZ AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6338
Practice Address - Country:US
Practice Address - Phone:814-880-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABACB394380103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst