MEDICARE: ANTONIA BERELSMAN

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	106S00000X	Behavior Technician	RBT-21-167712	IN
2	103K00000X	Behavior Analyst	1-23-68357	IN

General Provider Information

NPI Number	:	1619542594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIA BERELSMAN

Provider Business Mailing Address
First Line	:	12938 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-9517
Country	:	US
Telephone Number	:	317-815-5501
Fax Number	:	327-520-4144

Provider Business Practice Location Address
First Line	:	4422 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6917
Country	:	US
Telephone Number	:	260-471-9263
Fax Number	:	317-520-8200

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

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	01/13/2026

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Directions to “ ANTONIA BERELSMAN ” Practice Location

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