Healthcare Provider Details

I. General information

NPI: 1821386442
Provider Name (Legal Business Name): TERESA CASTELLANOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2011
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N WESTERN AVE SUITE 406
CHICAGO IL
60622-1797
US

IV. Provider business mailing address

1908 SOLUTIONS CTR
CHICAGO IL
60677-1009
US

V. Phone/Fax

Practice location:
  • Phone: 312-633-5841
  • Fax:
Mailing address:
  • Phone: 312-633-5841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.012879
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: