Provider Demographics
NPI:1396851432
Name:PRANTIL, JOSEPH E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:E
Last Name:PRANTIL
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 1:3544 LINCOLN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401
Mailing Address - Country:US
Mailing Address - Phone:801-393-3345
Mailing Address - Fax:801-393-3546
Practice Address - Street 1:3544 LINCOLN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401
Practice Address - Country:US
Practice Address - Phone:801-393-3345
Practice Address - Fax:801-393-3546
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10776535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical