Healthcare Provider Details

I. General information

NPI: 1750812111
Provider Name (Legal Business Name): CHRISTINE MANUEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 OPUS PL STE 110
DOWNERS GROVE IL
60515-1164
US

IV. Provider business mailing address

8667 CLIFFORD DR
DARIEN IL
60561-1630
US

V. Phone/Fax

Practice location:
  • Phone: 708-400-9146
  • Fax:
Mailing address:
  • Phone: 630-632-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.015982
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: