Provider Demographics
NPI:1992351712
Name:LEONE, CHRISTINE SOFIA
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:SOFIA
Last Name:LEONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CUSTER AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3597
Mailing Address - Country:US
Mailing Address - Phone:847-772-2199
Mailing Address - Fax:
Practice Address - Street 1:235 CUSTER AVE APT 2S
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3597
Practice Address - Country:US
Practice Address - Phone:847-772-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490210331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical