Basic Information
| Provider Information | |||||||||
| NPI: | 1023415213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARBLE | ||||||||
| FirstName: | LEA | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SAINT ANTHONYS WAY | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620024568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184635730 | ||||||||
| FaxNumber: | 6184651355 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 E 5TH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620026471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184635278 | ||||||||
| FaxNumber: | 6184746242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2014 | ||||||||
| LastUpdateDate: | 12/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149.012400 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.