| Stephen J. Antonello, Incorporated | |
|
66 Thompson Ave E Suite 102 West St Paul MN 55118-3184 | |
| (651) 688-2335 | |
| (651) 688-2669 |
| Full Name | Stephen J. Antonello, Incorporated |
|---|---|
| Speciality | Psychologist |
| Location | 66 Thompson Ave E, West St Paul, Minnesota |
| Authorized Official Name and Position | Stephen John Antonello (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 6516882335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stephen J. Antonello, Incorporated 825 Deer Trail Pt Mendota Heights MN 55118-2750 Ph: (651) 688-2335 | Stephen J. Antonello, Incorporated 66 Thompson Ave E Suite 102 West St Paul MN 55118-3184 Ph: (651) 688-2335 |
| NPI Number | 1326147133 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 01/30/2017 |
| Medicare PECOS PAC ID | 4183638778 |
|---|---|
| Medicare Enrollment ID | O20070223000206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326147133 | NPI | - | NPPES |
| DF8617 | Other | RAILROAD MEDICARE GRP ID | |
| 103667 | Other | MN | UCARE |
| 59778AN | Other | MN | BC BS GROUP ID |
| 760249900 | Medicaid | MN | |
| 6119337 | Other | MEDICA | |
| 73464 | Other | MN | HEALTH PARTNERS GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP1390 (Minnesota) | Primary |
| Provider Name | Stephen J Antonello |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760548366 PECOS PAC ID: 3072551266 Enrollment ID: I20050419000649 |
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