Provider Demographics
NPI:1548342744
Name:BELLENO, PATRICIA A (MS LCPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:BELLENO
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4571
Mailing Address - Country:US
Mailing Address - Phone:847-949-8685
Mailing Address - Fax:
Practice Address - Street 1:119 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4571
Practice Address - Country:US
Practice Address - Phone:847-840-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627977OtherBCBS