Provider Demographics
NPI:1649728221
Name:ANTAL, JOHN JOSEPH (LICSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:ANTAL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1648
Mailing Address - Country:US
Mailing Address - Phone:681-588-0357
Mailing Address - Fax:681-588-0358
Practice Address - Street 1:2101 JACOB ST
Practice Address - Street 2:SUITE 501
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3800
Practice Address - Country:US
Practice Address - Phone:304-234-8517
Practice Address - Fax:304-234-8745
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0008182SUPV1041C0700X
WVDP009384861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical