1811148117 NPI number — DR. RHEA DENISE ANTONIO PSY.D.

Table of content: DR. RHEA DENISE ANTONIO PSY.D. (NPI 1811148117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811148117 NPI number — DR. RHEA DENISE ANTONIO PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANTONIO
Provider First Name:
RHEA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811148117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 SILVER MINE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01833-1601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-618-3419
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 BEACON ST
Provider Second Line Business Practice Location Address:
BOSTON INSTITUTE FOR PSYCHOTHERAPY
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02446-4816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-566-7914
Provider Business Practice Location Address Fax Number:
617-278-0200
Provider Enumeration Date:
10/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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