Provider Demographics
NPI:1003028796
Name:STERLACCI, PAUL (LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:STERLACCI
Suffix:
Gender:M
Credentials:LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 LAKE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2864
Mailing Address - Country:US
Mailing Address - Phone:651-639-0865
Mailing Address - Fax:
Practice Address - Street 1:2375 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1631
Practice Address - Country:US
Practice Address - Phone:651-642-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2567103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling