MEDICARE: CHRISTINE KANE BERTOLINO MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	004803	MO

General Provider Information

NPI Number	:	1295307692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE KANE BERTOLINO MSW, LCSW

Provider Business Mailing Address
First Line	:	8772 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3730
Country	:	US
Telephone Number	:	314-962-7788
Fax Number	:

Provider Business Practice Location Address
First Line	:	8772 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3730
Country	:	US
Telephone Number	:	314-962-7788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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