NPI 1104354307 · live from the CMS NPI Registry
Rafaela Antoniadou
Behavior Analyst in Rockwood, MI. National Provider Identifier 1104354307, active.
NPI record
| NPI | 1104354307 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 31745 E Ditner Dr, Rockwood, MI 48173 |
| Practice phone | 313-723-3609 |
| Enumerated | June 1, 2017 |
| Last updated | November 3, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Technician | 106S00000X | — |
| Behavior Analyst | 103K00000X | — |
| Behavior Analyst primary | 103K00000X | 7401001944 (MI) |
| Technician/Technologist | 156F00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.