Healthcare Provider Details

I. General information

NPI: 1356098651
Provider Name (Legal Business Name): ANTONIA CIUNCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E 94TH ST APT 1
NEW YORK NY
10128-2905
US

IV. Provider business mailing address

200 WATER ST APT 524
NEW YORK NY
10038-3613
US

V. Phone/Fax

Practice location:
  • Phone: 914-295-2419
  • Fax:
Mailing address:
  • Phone: 401-862-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP113659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: