Provider Demographics
NPI:1316477631
Name:ANTONIOLI, BERKELEY HARBOUR (PHD, LCSW, MED)
Entity type:Individual
Prefix:DR
First Name:BERKELEY
Middle Name:HARBOUR
Last Name:ANTONIOLI
Suffix:
Gender:F
Credentials:PHD, LCSW, MED
Other - Prefix:
Other - First Name:BERKELEY
Other - Middle Name:ROSE
Other - Last Name:HARBOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, MED
Mailing Address - Street 1:192 FRENCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6536
Mailing Address - Country:US
Mailing Address - Phone:302-343-1739
Mailing Address - Fax:302-298-0915
Practice Address - Street 1:192 FRENCHTOWN RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6536
Practice Address - Country:US
Practice Address - Phone:302-343-1739
Practice Address - Fax:302-298-0915
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD260571041C0700X
DEQ1-00015531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty