Healthcare Provider Details

I. General information

NPI: 1023415213
Provider Name (Legal Business Name): LEA ANNE VARBLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E 5TH ST SUITE 101
ALTON IL
62002-6471
US

IV. Provider business mailing address

1 SAINT ANTHONYS WAY
ALTON IL
62002-4568
US

V. Phone/Fax

Practice location:
  • Phone: 618-463-5278
  • Fax: 618-474-6242
Mailing address:
  • Phone: 618-463-5730
  • Fax: 618-465-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.012400
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: