Provider Demographics
NPI:1336557966
Name:BERGANTINO, AMANDA (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BERGANTINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BATTERSON PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-4502
Mailing Address - Country:US
Mailing Address - Phone:870-284-1177
Mailing Address - Fax:860-284-1125
Practice Address - Street 1:20 BATTERSON PARK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-4502
Practice Address - Country:US
Practice Address - Phone:870-284-1177
Practice Address - Fax:860-284-1125
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical