Healthcare Provider Details

I. General information

NPI: 1003465600
Provider Name (Legal Business Name): CHRISTINE ANNE O'TOOLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CALLE PORTAL STE C240
SIERRA VISTA AZ
85635-2986
US

IV. Provider business mailing address

1133 W WILSON ST APT C
BATAVIA IL
60510-1884
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-8669
  • Fax:
Mailing address:
  • Phone: 630-770-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.021531
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: