Healthcare Provider Details

I. General information

NPI: 1134507247
Provider Name (Legal Business Name): CELINA CANTU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 W DIVISION ST
CHICAGO IL
60651-2405
US

IV. Provider business mailing address

1220 S WOOD ST
CHICAGO IL
60608-1202
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-7425
  • Fax:
Mailing address:
  • Phone: 312-413-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149020973
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: