MEDICARE: DENISE N ANTONIO

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	251S00000X	Community/Behavioral Health Agency
2	385HR2055X	Child Mental Illness Respite Care	385HR2055X	AZ
3	253J00000X	Foster Care Agency
4	174400000X	Specialist

General Provider Information

NPI Number	:	1568642643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE N ANTONIO

Provider Business Mailing Address
First Line	:	1098 N HOBBLE STRAP ST
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-1445
Country	:	US
Telephone Number	:	928-273-9023
Fax Number	:

Provider Business Practice Location Address
First Line	:	1098 N HOBBLE STRAP ST
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-1445
Country	:	US
Telephone Number	:	928-273-9023
Fax Number	:

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

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	03/19/2026

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Directions to “ DENISE N ANTONIO ” Practice Location

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