Judy Lee Antonello, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP0444 Issued in MN

Practice address

260 Wentworth Ave E # 124
West St Paul, MN 55118-3525

Phone

(651) 688-2335

Fax

(651) 688-2669

NPI assigned

Sep 21, 2006

Last updated

Feb 28, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1999

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ronald L Hoschouer Inc

  • Clinical Psychologist
  • West St Paul, MN
  • NPI 1376641688
  NPD (past)
• Stephen J. Antonello, Incorporated

  • Clinical Psychologist
  • West St Paul, MN
  • NPI 1326147133
  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614470400000",
    "number": "1235238049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 DEER TRAIL PT",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551182750",
            "telephone_number": "651-688-2335",
            "fax_number": "651-688-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 WENTWORTH AVE E # 124",
            "city": "WEST ST PAUL",
            "state": "MN",
            "postal_code": "551183525",
            "telephone_number": "651-688-2335",
            "fax_number": "651-688-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONELLO",
        "first_name": "JUDY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2021-02-28",
        "certification_date": "2021-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP0444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allen Rydberg P.a. (Restore-U Chiropractic)
• Allina Health System (Allina Health West St Paul Clinic)
• Ally Supportive Services, LLC
• Timothy Alworth Anderson, D.D.S
• Margaret Andrew, PHARMD
• Stephen John Antonello, PH.D.
• Apex Home Care, LLC (NA)
• Aspire Care Services (Aspire Comfort Home Health Care)
• Mariam Awad
• Back in Balance Chiropractic, PA (wildenauer chiropractic clinic)

• Clinical Psychologist in West St Paul, MN
• Providers in West St Paul, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.