Healthcare Provider Details

I. General information

NPI: 1154213395
Provider Name (Legal Business Name): PATRICIA ANTOINE-LACKISH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 ASBURY ANDERSON RD
ASBURY NJ
08802-1040
US

IV. Provider business mailing address

238 ASBURY ANDERSON RD
ASBURY NJ
08802-1040
US

V. Phone/Fax

Practice location:
  • Phone: 484-529-9140
  • Fax:
Mailing address:
  • Phone: 484-529-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP035161
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025028608
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: