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
Phone: (651) 688-2335
Fax: (651) 688-2669
Website:
Health care specialties
| Specialty | Code | License # | 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 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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