Provider Demographics
NPI:1821783689
Name:LAMONTE, BREANNA VERONICA (BA)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:VERONICA
Last Name:LAMONTE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MCCAUSLAND ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-9133
Mailing Address - Country:US
Mailing Address - Phone:217-930-2106
Mailing Address - Fax:217-716-2265
Practice Address - Street 1:101 MCCAUSLAND ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-9133
Practice Address - Country:US
Practice Address - Phone:217-930-2106
Practice Address - Fax:217-716-2265
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor