Richard Justin Antall, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

S.0801090 Issued in OH

Practice address

3737 Lander Road
Pepper Pike, OH 44124-5712

Phone

(216) 831-2255

Fax

(216) 378-3906

NPI assigned

Oct 18, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• R. Justin Antall Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544918400000",
    "number": "1578873113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "384 SADDLER RD",
            "city": "BAY VILLAGE",
            "state": "OH",
            "postal_code": "441401118",
            "telephone_number": "440-567-3063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 LANDER ROAD",
            "city": "PEPPER PIKE",
            "state": "OH",
            "postal_code": "441245712",
            "telephone_number": "216-831-2255",
            "fax_number": "216-378-3906"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "384 Saddler Rd",
            "address_purpose": "LOCATION",
            "city": "Bay Village",
            "state": "OH",
            "postal_code": "441401118",
            "country_code": "US",
            "telephone_number": "440-567-3063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTALL",
        "first_name": "RICHARD",
        "middle_name": "JUSTIN",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-18",
        "last_updated": "2018-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S.0801090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0268768",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "R. JUSTIN",
            "last_name": "ANTALL",
            "credential": "LISW-S",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Clinical Social Worker in Pepper Pike, OH
• Providers in Pepper Pike, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.