Judy Lee Antonello, PH.D.
NPI 1235238049ActiveIndividual· Psychologist, Clinical· West St Paul, MN
Psychologist, Clinical (PH.D.) in West St Paul, Minnesota, licensed in MN, with an NPI issued in September 2006. Enrolled in Medicare as practitioner - clinical psychologist.
Overview
| NPI | 1235238049 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PH.D. |
| Sole proprietor | Yes |
| NPI issued | Sep 21, 2006 |
| Last updated in NPPES | Feb 28, 2021 |
| Certified by provider | Feb 28, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | LP0444 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Psychologist (MN) |
|---|
Education and affiliations
| Graduation year | 1999 |
|---|---|
| Medicare specialty | Clinical Psychologist |
| Telehealth | Offers telehealth |
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