Healthcare Provider Details

I. General information

NPI: 1649728221
Provider Name (Legal Business Name): JOHN JOSEPH ANTAL LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 JACOB ST SUITE 501
WHEELING WV
26003-3800
US

IV. Provider business mailing address

90 N 4TH ST
MARTINS FERRY OH
43935-1648
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-8517
  • Fax: 304-234-8745
Mailing address:
  • Phone: 681-588-0357
  • Fax: 681-588-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0008182SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00938486
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: