| Darlene B Antonio Phd Llc | |
|
2700 Westhall Ln Suite 110 Maitland FL 32751-7403 | |
| (407) 475-1025 | |
| (407) 475-1027 |
| Full Name | Darlene B Antonio Phd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2700 Westhall Ln, Maitland, Florida |
| Authorized Official Name and Position | Darlene B Antonio (MANAGING MEMBER) |
| Authorized Official Contact | 4074751025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Darlene B Antonio Phd Llc 2700 Westhall Ln Suite 110 Maitland FL 32751-7403 Ph: (407) 475-1025 | Darlene B Antonio Phd Llc 2700 Westhall Ln Suite 110 Maitland FL 32751-7403 Ph: (407) 475-1025 |
| NPI Number | 1326101528 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 08/08/2007 |
| Medicare PECOS PAC ID | 3971601840 |
|---|---|
| Medicare Enrollment ID | O20070531000437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326101528 | NPI | - | NPPES |
| AC481 | Other | FL | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY4189 (Florida) | Primary |
| Provider Name | Darlene Antonio |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801850433 PECOS PAC ID: 1355445248 Enrollment ID: I20070403000101 |
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