Stanley Thomas Antonelli III, L.C.S.W., L.C.A.C.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34005677A Issued in IN

Practice address

4004 Pleasant Dr
Kokomo, IN 46902-5858

Phone

(574) 727-1833

NPI assigned

Feb 15, 2013

Last updated

Feb 15, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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 Social Worker

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psychotherapy Associates of Kokomo, LLCGroup PAC ID 0143646323, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Psychotherapy Associates of Kokomo, LLC

  • Clinical Social Worker
  • Kokomo, IN
  • NPI 1447868906
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1360886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360886400000",
    "number": "1720328446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 PLEASANT DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469025858",
            "telephone_number": "574-727-1833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 PLEASANT DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469025858",
            "telephone_number": "574-727-1833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONELLI",
        "first_name": "STANLEY",
        "middle_name": "THOMAS",
        "name_suffix": "III",
        "credential": "L.C.S.W., L.C.A.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-15",
        "last_updated": "2013-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87001442A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005677A",
            "primary": true
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "IN",
            "license": "1619240",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Andrews
• Stanton Angermeier, MD
• Aspen Nichole Anglin, RBT
• Kingsley Annan, MD
• Sarto I Antao, MD
• Skyler Breanne Apolo, MS, BCBA
• Alexandria Apostol
• Applegate Health Services, Inc. (AppleGate Recovery Kokomo)
• Savannah Arbuckle
• Jessica Ann Ardi, FNP

• Clinical Social Worker in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2013; 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.