Healthcare Provider Details

I. General information

NPI: 1669265138
Provider Name (Legal Business Name): CELIA CASTULO I LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11560 S KEDZIE AVE STE 200
MERRIONETTE PARK IL
60803-4517
US

IV. Provider business mailing address

11560 S KEDZIE AVE STE 200
MERRIONETTE PARK IL
60803-4517
US

V. Phone/Fax

Practice location:
  • Phone: 708-974-5800
  • Fax: 708-974-2498
Mailing address:
  • Phone: 708-974-5800
  • Fax: 708-974-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150114524
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: