Healthcare Provider Details

I. General information

NPI: 1740060516
Provider Name (Legal Business Name): AMANDA LENTINI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 MICHELLE DR
BELLEVILLE IL
62226-6309
US

IV. Provider business mailing address

4009 MICHELLE DR
BELLEVILLE IL
62226-6309
US

V. Phone/Fax

Practice location:
  • Phone: 618-606-4114
  • Fax:
Mailing address:
  • Phone: 636-212-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.041473
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2026011005
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: