Healthcare Provider Details

I. General information

NPI: 1215307111
Provider Name (Legal Business Name): CHRISTINA LEA AQUINO LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 1ST AVE SE STE 416
CEDAR RAPIDS IA
52402-3221
US

IV. Provider business mailing address

4314 HOLLY CIR NE
CEDAR RAPIDS IA
52411-4726
US

V. Phone/Fax

Practice location:
  • Phone: 641-781-0538
  • Fax:
Mailing address:
  • Phone: 641-781-0538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number008216
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008216
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: