Provider Demographics
NPI:1407907462
Name:ANTOINE, MARIE BERTHONIA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:BERTHONIA
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2277
Mailing Address - Country:US
Mailing Address - Phone:617-828-7447
Mailing Address - Fax:617-296-5552
Practice Address - Street 1:1424 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2277
Practice Address - Country:US
Practice Address - Phone:617-828-7447
Practice Address - Fax:617-296-5552
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health