MEDICARE: MRS. CHRISTINA L. LINBOOM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	149.013328	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149.013328	OTHER	IL	IL DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION- SOCIAL WORK BOARD

General Provider Information

NPI Number	:	1629136882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA L. LINBOOM LCSW

Provider Business Mailing Address
First Line	:	6501 S PROMONTORY DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-1002
Country	:	US
Telephone Number	:	773-753-8642
Fax Number	:	773-247-2188

Provider Business Practice Location Address
First Line	:	6501 S PROMONTORY DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-1002
Country	:	US
Telephone Number	:	773-753-8642
Fax Number	:	773-247-2188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	09/03/2020

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