Provider Demographics
NPI:1154213395
Name:ANTOINE-LACKISH, PATRICIA (PMHNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ANTOINE-LACKISH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 ASBURY ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08802-1040
Mailing Address - Country:US
Mailing Address - Phone:484-529-9140
Mailing Address - Fax:
Practice Address - Street 1:238 ASBURY ANDERSON RD
Practice Address - Street 2:
Practice Address - City:ASBURY
Practice Address - State:NJ
Practice Address - Zip Code:08802-1040
Practice Address - Country:US
Practice Address - Phone:484-529-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2025028608163WP0807X, 163WP0809X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult