Stephen John Antonello, PH.D.
Individual provider Active NPI Clinical Psychologist · West St Paul, MN
NPI 1760548366 · NPPES record last updated Jan 30, 2017
Key facts
- NPI
- 1760548366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- LP1390 (MN)
- Practice address
- 66 Thompson Ave E
Suite 102
West St Paul, MN 55118-3184 - Phone
- (651) 688-2335
- Fax
- (651) 688-2669
- NPI assigned
- Dec 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
260 Wentworth Ave E
Suite 124
West St Paul, MN 55118-3525
Phone (651) 688-2335
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050419000649 | MN | Practitioner - Clinical Psychologist | 3072551266 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stephen J. Antonello, Incorporated | Clinical | Current |
Accepting new patients |
Locations
750 S Plaza Dr
Ste 104
Saint Paul, MN 55120
Phone (651) 406-4454
260 Wentworth Ave E
#124
West St Paul, MN 55118
Phone (651) 688-2335
66 Thompson Ave E
Ste 102
West St Paul, MN 55118
Phone (651) 688-2335
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP1390 | MN | Yes |
Addresses
Primary practice location
66 Thompson Ave E
Suite 102
West St Paul, MN 55118-3184
Mailing address
825 Deer Trail PT
Mendota Heights, MN 55118-2750
Phone (651) 688-2335
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103667 | Other | MN | UCARE |
| 148547400 | Medicaid | MN | |
| P00393789 | Other | RAILROAD MEDICARE INDIV# | |
| 6119337 | Other | MEDICA | |
| OE222AN | Other | MN | BC BS INDIVIDUAL ID |
| HP40542 | Other | MN | HEALTH PARTNERS INDIVIDUA |
Other providers in West St Paul, MN
- Allina Health System
- Ally Supportive Services, LLC
- Timothy Alworth Anderson
- Margaret Andrew
- Judy Lee Antonello
- Apex Home Care, LLC
- Aspire Care Services
- Mariam Awad
- Back in Balance Chiropractic, PA
- Melissa Baughman
All providers in West St Paul, MN · Clinical Psychologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.