Healthcare Provider Details

I. General information

NPI: 1871768135
Provider Name (Legal Business Name): CYNTHIA ISABEL CASTRO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 N KEDZIE AVE
CHICAGO IL
60618-7602
US

IV. Provider business mailing address

2828 N KEDZIE AVE
CHICAGO IL
60618-7602
US

V. Phone/Fax

Practice location:
  • Phone: 773-486-8153
  • Fax:
Mailing address:
  • Phone: 773-486-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.010752
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2238659
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: