Christine Kane Bertolino, MSW, LCSW

Key facts

NPI

1295307692

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

004803 (MO)

Practice address

8772 Big Bend Blvd
Webster Groves, MO 63119-3730

Phone

(314) 962-7788

NPI assigned

Jul 14, 2021

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Creative Change, LLC Clinical Psychologist · Ellisville, MO · NPI 1760515498
  NPD CLINICAL

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

National Provider Directory

Medicare enrollment (NPD)

Yes

Practice roles

Locations

Specialties & licenses

Addresses

Other names

• Christine Lynn Kane Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 14, 2021.

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1295307692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8772 BIG BEND BLVD",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631193730",
            "telephone_number": "314-962-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8772 BIG BEND BLVD",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631193730",
            "telephone_number": "314-962-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTOLINO",
        "first_name": "CHRISTINE",
        "middle_name": "KANE",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "004803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "KANE",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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All providers in Webster Groves, MO · Clinical Social Worker in Missouri