Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP 2567 | MN |
NPI | 1003028796 |
---|---|
Provider Name | Mr. Paul Sterlacci |
First Address | Arden Hills, MN 55112-2864 |
Second Address | Saint Paul, MN 55114-1631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |