Organization
STEPHEN J. ANTONELLO, INCORPORATED
Active
Organization
STEPHEN J. ANTONELLO, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN JOHN ANTONELLO PH.D. (LICENSED PSYCHOLOGIST)
(651) 688-2335
Entity
Organization
Contact information
Practice address
66 THOMPSON AVE E, SUITE 102, WEST ST PAUL, MN 55118-3184
(651) 688-2335
(651) 688-2669
Mailing address
825 DEER TRAIL PT, MENDOTA HEIGHTS, MN 55118-2750
(651) 688-2335
(651) 688-2669
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP1390
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103667
UCARE
MN
01
—
59778AN
BC BS GROUP ID
MN
01
—
6119337
MEDICA
—
01
—
73464
HEALTH PARTNERS GROUP
MN
05
—
760249900
—
MN
01
—
DF8617
RAILROAD MEDICARE GRP ID
—
Enumeration date
09/21/2006
Last updated
01/30/2017
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