Provider Demographics
NPI:1710971247
Name:SANGREGORY, ALBERT J (LISW)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:J
Last Name:SANGREGORY
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1110 CASTALIA ST
Mailing Address - Street 2:STE B
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-1181
Mailing Address - Country:US
Mailing Address - Phone:419-483-6086
Mailing Address - Fax:419-483-3125
Practice Address - Street 1:1110 CASTALIA ST
Practice Address - Street 2:STE B
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-1181
Practice Address - Country:US
Practice Address - Phone:419-483-6086
Practice Address - Fax:419-483-3125
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00053511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000115697OtherANTHEM BLUE CROSS
38740OtherUNITED HEALTHCARE
P00039605OtherRAILROAD MEDICARE
P00039605OtherRAILROAD MEDICARE