| NPI | 1326147133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN JOHN ANTONELLO Licensed Psychologist 651-688-2335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP1390) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2017-01-30 |