Provider Demographics
NPI:1164689782
Name:BARBA, ANTONIA (LMSW)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:BARBA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 ISELIN AVE
Mailing Address - Street 2:C/O HENRY ITTLESON CENTER
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2915
Mailing Address - Country:US
Mailing Address - Phone:718-549-6700
Mailing Address - Fax:718-796-4614
Practice Address - Street 1:5050 ISELIN AVE
Practice Address - Street 2:C/O HENRY ITTLESON CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2915
Practice Address - Country:US
Practice Address - Phone:718-549-6700
Practice Address - Fax:718-796-4614
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074586-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical