Healthcare Provider Details

I. General information

NPI: 1548826407
Provider Name (Legal Business Name): SOFIA CASAS LCAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 N LEAVITT ST UNIT 2
CHICAGO IL
60618-4808
US

IV. Provider business mailing address

3717 N LEAVITT ST UNIT 2
CHICAGO IL
60618-4808
US

V. Phone/Fax

Practice location:
  • Phone: 646-812-8271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: