Provider Demographics
NPI:1427797984
Name:ANTAYA, MONIQUE (MED BCBA LABA-VT)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:ANTAYA
Suffix:
Gender:F
Credentials:MED BCBA LABA-VT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTERFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03466-3209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86 CROSS RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTERFIELD
Practice Address - State:NH
Practice Address - Zip Code:03466-3209
Practice Address - Country:US
Practice Address - Phone:603-545-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-11-9054103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst