Individual
DR. STEPHEN JOHN ANTONELLO
Active
Individual
DR. STEPHEN JOHN ANTONELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
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
05
—
148547400
—
MN
01
—
6119337
MEDICA
—
01
—
HP40542
HEALTH PARTNERS INDIVIDUA
MN
01
—
OE222AN
BC BS INDIVIDUAL ID
MN
01
—
P00393789
RAILROAD MEDICARE INDIV#
—
Enumeration date
12/28/2006
Last updated
01/30/2017
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