| Doctor Name: | DR. JUDY LEE ANTONELLO |
| NPI Number: | 1235238049 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | LP0444 |
| Business Practice Address: | 1700 Livingston Ave Suite 215 West St Paul, MN - 551185908 |
| Business Phone Number: | 6516882335 |
| Business Fax Number: | 6516882669 |
| Mailing Address: | 1700 Livingston Ave, Suite 215 WEST ST PAUL |
| State: | MN |
| Postal Code: | 551185908 |
| Phone Number: | 6516882335 |
| Fax Number: | 6516882669 |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 04/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP0444 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |