Healthcare Provider Details

I. General information

NPI: 1437070968
Provider Name (Legal Business Name): NORA BAUTISTA-O'NEAL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S WILLIAM ST
SOUTH BEND IN
46601-2515
US

IV. Provider business mailing address

201 S WILLIAM ST
SOUTH BEND IN
46601-2515
US

V. Phone/Fax

Practice location:
  • Phone: 574-234-2870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33011880A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: