MEDICARE: CASTRO JACOBS PSYCHOTHERAPY AND CONSULTING

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

General Provider Information

NPI Number	:	1295393734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTRO JACOBS PSYCHOTHERAPY AND CONSULTING

Provider Business Mailing Address
First Line	:	205 N MICHIGAN AVE STE 1660
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-6022
Country	:	US
Telephone Number	:	312-766-4612
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 N MICHIGAN AVE STE 1660
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-6022
Country	:	US
Telephone Number	:	312-766-4612
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	CHELSY CASTRO
Credential	:	LCSW
Telephone Number	:	312-766-4612

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	06/11/2019

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