Provider Demographics
NPI:1679388425
Name:ANTONUCCI, RACHEL LINDSAY (MA, BCBA, LBA)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LINDSAY
Last Name:ANTONUCCI
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4804
Mailing Address - Country:US
Mailing Address - Phone:631-579-8395
Mailing Address - Fax:
Practice Address - Street 1:4250 SUNRISE HWY STE 106
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5352
Practice Address - Country:US
Practice Address - Phone:516-640-0798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003783103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst