MEDICARE: JENNIFER ANTONUCCI LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MI0733	NV

General Provider Information

NPI Number	:	1609270974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANTONUCCI LMFT

Provider Business Mailing Address
First Line	:	10994 LADYBURN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4358
Country	:	US
Telephone Number	:	702-235-9396
Fax Number	:

Provider Business Practice Location Address
First Line	:	3243 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3185
Country	:	US
Telephone Number	:	702-434-7290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	07/03/2019

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