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Individual
MRS. LISA A ANTONICK
Active
Individual
MRS. LISA A ANTONICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C006509
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000403187001
BS NE NY
—
05
—
02348474
—
NY
01
—
040426032094
FIDELIS
—
01
—
248368
VALUE OPTIONS
—
01
—
257617
COM PSYCH
—
01
—
326051
MHN
—
01
—
361170
MVP
—
01
—
537788000
MAGELLAN
—
05
—
6007404
—
NC
01
—
GROUP NUMBER
BLUE CROSS OF NORTH CAROLINA
NC
01
—
N7L561
EMPIRE
—
Enumeration date
08/07/2006
Last updated
09/08/2026
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