Healthcare Provider Details

I. General information

NPI: 1881249621
Provider Name (Legal Business Name): SONIA CASTANEDA MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 E STATE ST STE B
ROCKFORD IL
61108-2272
US

IV. Provider business mailing address

621 MEADOW LN
HARVARD IL
60033-8359
US

V. Phone/Fax

Practice location:
  • Phone: 815-227-9002
  • Fax: 815-227-9070
Mailing address:
  • Phone: 815-354-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150103863
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: