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Individual
STANLEY THOMAS ANTONELLI III
Active
Individual
STANLEY THOMAS ANTONELLI III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.C.S.W., L.C.A.C.
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001442A
IN
1041C0700X
Clinical Social Worker
Primary
34005677A
IN
1041S0200X
School Social Worker
1619240
IN
Other
Enumeration date
02/15/2013
Last updated
02/15/2013
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