Healthcare Provider Details

I. General information

NPI: 1023756665
Provider Name (Legal Business Name): CHRISTINE VERENISE CONRADO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 MEDICAL DR STE 1
BRIGHAM CITY UT
84302-3094
US

IV. Provider business mailing address

1455 W 2200 S STE 300
WEST VALLEY UT
84119-7219
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-8276
  • Fax:
Mailing address:
  • Phone: 801-412-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9790371-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: