Healthcare Provider Details

I. General information

NPI: 1821662131
Provider Name (Legal Business Name): RICHARD ANTASH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 164TH ST
JAMAICA NY
11432-1118
US

IV. Provider business mailing address

8115 164TH ST
JAMAICA NY
11432-1118
US

V. Phone/Fax

Practice location:
  • Phone: 718-380-3000
  • Fax:
Mailing address:
  • Phone: 718-380-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109668
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: