Individual
MICHAEL THOMAS ANTONELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
945 RIVER AVE, LAKEWOOD, NJ 08701-5659
(732) 833-3723
Mailing address
945 RIVER AVE, LAKEWOOD, NJ 08701-5659
(732) 833-3723
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-55485
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OSC89393268-01
—
NJ
Enumeration date
11/26/2021
Last updated
11/26/2021
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