Basic Information
| Provider Information | |||||||||
| NPI: | 1649728221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTAL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | MARTINS FERRY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439351648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6815880357 | ||||||||
| FaxNumber: | 6815880358 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 JACOB ST | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260033800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042348517 | ||||||||
| FaxNumber: | 3042348745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2016 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I0008182SUPV | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | DP00938486 | WV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.