Provider Demographics
NPI:1700292059
Name:LITTLE, ANTOINETE
Entity type:Individual
Prefix:
First Name:ANTOINETE
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 E ORMOND AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2052
Mailing Address - Country:US
Mailing Address - Phone:856-427-6584
Mailing Address - Fax:856-427-0957
Practice Address - Street 1:22 E ORMOND AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2052
Practice Address - Country:US
Practice Address - Phone:856-427-6584
Practice Address - Fax:856-427-0957
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst