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General NPI Number Information
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NPI Number | 1629136882
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Entity Type | Individual
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Provider Name | CHRISTINA L. LINBOOM LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 6501 S PROMONTORY DR
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City | CHICAGO
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State | IL
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Zip | 60649-1002
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Country | US
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Telephone | 773-753-8642
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Fax | 773-247-2188
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Provider Business Mailing Address
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Address Line | 6501 S PROMONTORY DR
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City | CHICAGO
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State | IL
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Zip | 60649-1002
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Country | US
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Telephone | 773-753-8642
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Fax | 773-247-2188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.013328
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License Number State | IL
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