Provider Demographics
NPI:1205633864
Name:CAVALLARO, CHRISTINE M (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:CAVALLARO
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20509 DEMINGS DR
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-8406
Mailing Address - Country:US
Mailing Address - Phone:815-922-7051
Mailing Address - Fax:
Practice Address - Street 1:806 DEKALB AVE STE 3
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2050
Practice Address - Country:US
Practice Address - Phone:630-297-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0268401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical