Antonello, Stephen John

Antonello, Stephen John is an sole proprietor health care provider with primary practice located at 66 Thompson Ave E Suite 102, West St Paul MN 55118-3184. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Antonello, Stephen John can be contacted via phone (651) 688-2335.

Contact Information

Primary practice address
66 Thompson Ave E Suite 102 West St Paul MN 55118-3184
Fax: (651) 688-2669
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X LP1390 Minnesota

Profile Details

NPI number 1760548366
LBN Legal business name Antonello, Stephen John
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 28th, 2006
Last updated Jan 30th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760548366 NPPES
Minnesota Other 103667 UCARE
Minnesota MEDICAID 148547400 UCARE
Minnesota Other P00393789 UCARE
Minnesota Other 6119337 UCARE
Minnesota Other OE222AN UCARE
Minnesota Other HP40542 UCARE

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