Organization
DARLENE B ANTONIO PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARLENE B ANTONIO PH.D. (MANAGING MEMBER)
(407) 475-1025
Entity
Organization
Contact information
Practice address
2700 WESTHALL LN, SUITE 110, MAITLAND, FL 32751-7403
(407) 475-1025
(407) 475-1027
Mailing address
2700 WESTHALL LN, SUITE 110, MAITLAND, FL 32751-7403
(407) 475-1025
(407) 475-1027
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY4189
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC481
MEDICARE PTAN
FL
Enumeration date
12/18/2006
Last updated
08/08/2007
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