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General NPI Number Information
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NPI Number | 1366944761
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Entity Type | Individual
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Provider Name | DIANA CASTILLO LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 1041 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60622-3571
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Country | US
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Telephone | 312-834-3490
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Fax |
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Provider Business Mailing Address
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Address Line | 2808 W NORTH AVE UNIT 4E
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City | CHICAGO
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State | IL
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Zip | 60647-7494
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Country | US
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Telephone | 773-490-7900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149019243
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License Number State | IL
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