Stephen J. Antonello, Incorporated

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP1390 Issued in MN

Legal business name

STEPHEN J. ANTONELLO, INCORPORATED

Practice address

66 Thompson Ave E
Suite 102
West St Paul, MN 55118-3184

Phone

(651) 688-2335

Fax

(651) 688-2669

NPI assigned

Sep 21, 2006

Organization subpart

No

Name

Dr. Stephen John Antonello, PH.D.NPI 1760548366

Title

Licensed Psychologist

Phone

(651) 688-2335

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephen John Antonello, PH.D.

  • Clinical Psychologist
  • West St Paul, MN
  • NPI 1760548366

  Clinical, MN

  Medicare reassignment NPD Authorized official
• Judy Lee Antonello, PH.D.

  • Clinical Psychologist
  • West St Paul, MN
  • NPI 1235238049

  Clinical

  NPD (past)

Medicare fee-for-service enrollment

Enrolled in MN

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 30, 2017.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1326147133",
    "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": "66 THOMPSON AVE E",
            "address_2": "SUITE 102",
            "city": "WEST ST PAUL",
            "state": "MN",
            "postal_code": "551183184",
            "telephone_number": "651-688-2335",
            "fax_number": "651-688-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN J. ANTONELLO, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "ANTONELLO",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "651-688-2335",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP1390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GRP ID",
            "identifier": "DF8617",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "103667",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS GROUP ID",
            "identifier": "59778AN",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "760249900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6119337",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS GROUP",
            "identifier": "73464",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.