Provider Demographics
NPI:1760281612
Name:ANTONIADIS, MARIA V (PHD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:V
Last Name:ANTONIADIS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:V
Other - Last Name:ANTONIADIS-BINDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12613 LAUSANNE WAY
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-6400
Mailing Address - Country:US
Mailing Address - Phone:510-697-7354
Mailing Address - Fax:
Practice Address - Street 1:12613 LAUSANNE WAY
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-6400
Practice Address - Country:US
Practice Address - Phone:510-697-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical