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General NPI Number Information
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NPI Number | 1265561732
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Entity Type | Individual
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Provider Name | MADELINE T. DE ANTONIO L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16255 VENTURA BLVD SUITE 806
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City | ENCINO
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State | CA
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Zip | 91436-2302
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Country | US
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Telephone | 818-789-3187
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Fax | 818-789-3187
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Provider Business Mailing Address
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Address Line | 4924 BALBOA BLVD #481
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City | ENCINO
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State | CA
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Zip | 91316-3402
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Country | US
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Telephone | 818-789-3187
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Fax | 818-789-3187
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS2426
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License Number State | CA
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