MEDICARE: TRICIA ANTONIO LCSW

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	1041C0700X	Clinical Social Worker	SW 9260	FL

General Provider Information

NPI Number	:	1861652422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA ANTONIO LCSW

Provider Business Mailing Address
First Line	:	5825 SWORDFISH CT
Second Line	:	UNIT A
City	:	TAMARAC
State	:	FL
Zip	:	33319-6296
Country	:	US
Telephone Number	:	954-366-9842
Fax Number	:

Provider Business Practice Location Address
First Line	:	11820 MIRAMAR PKWY STE 224
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-5818
Country	:	US
Telephone Number	:	954-366-9842
Fax Number	:

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

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	03/09/2020

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Directions to “ TRICIA ANTONIO LCSW” Practice Location

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