Provider Demographics
NPI:1851075592
Name:BANAGAS, SYDNEY (CASUDC)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:BANAGAS
Suffix:
Gender:F
Credentials:CASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 S RIVER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-4712
Mailing Address - Country:US
Mailing Address - Phone:314-852-1739
Mailing Address - Fax:
Practice Address - Street 1:1223 S 620 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-3324
Practice Address - Country:US
Practice Address - Phone:314-852-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13363821-6018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)