Provider Information for 1609056332
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BRENDA ANTONACCI M.S., N.C.C., L.P.C.
Sex: Female
NPI: 1609056332
Last Updated: 2023-03-20
Certification Date: 2023-03-20
Certification Date: 2023-03-20
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1609056332 | ||||||||
| Enumeration Date | 2007-11-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 206 BERRY ST WEST PITTSTON, PA 18643-2320 United States Phone: 570-407-9810 | Fax: | ||||||||
| Primary Practice Address | 206 BERRY ST WEST PITTSTON, PA 18643-2320 United States Phone: 570-407-9810 | Fax: | ||||||||
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