Provider Demographics
NPI:1003837501
Name:ISTVAN, JOHN EMERY -------------------- (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN EMERY
Middle Name:--------------------
Last Name:ISTVAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-2425
Mailing Address - Country:US
Mailing Address - Phone:203-639-8820
Mailing Address - Fax:
Practice Address - Street 1:11 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-2425
Practice Address - Country:US
Practice Address - Phone:203-639-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0020821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R74914Medicare UPIN