Healthcare Provider Details

I. General information

NPI: 1902014848
Provider Name (Legal Business Name): MARIA CASTILLO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 S AUSTIN BLVD 213
CICERO IL
60804-2616
US

IV. Provider business mailing address

353 E QUINCY ST
RIVERSIDE IL
60546-2133
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-1130
  • Fax:
Mailing address:
  • Phone: 773-562-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149010129
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: