Provider Demographics
NPI:1346461274
Name:BELLEGANTE, SANDRA JEAN (BA, MSW, LSW, CADC,)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:BELLEGANTE
Suffix:
Gender:F
Credentials:BA, MSW, LSW, CADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 PERSIMMON AVE
Mailing Address - Street 2:
Mailing Address - City:MULBERRY GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:62262-3009
Mailing Address - Country:US
Mailing Address - Phone:618-533-1391
Mailing Address - Fax:618-533-0012
Practice Address - Street 1:101 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3506
Practice Address - Country:US
Practice Address - Phone:618-533-1391
Practice Address - Fax:618-533-1002
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCADC 20868101YA0400X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health