Basic Information
| Provider Information | |||||||||
| NPI: | 1568610798 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTILL | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | MAE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 JOHNSON RD | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439522363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402647751 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 732 N 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439521841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402841400 | ||||||||
| FaxNumber: | 7402841417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2008 | ||||||||
| LastUpdateDate: | 08/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S0018353 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 24-01 | 05 | OH | MEDICAID |