MEDICARE: MERARI E FERNANDEZ CASTRO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.014034	IL
2	1041C0700X	Clinical Social Worker	149014034	IL

General Provider Information

NPI Number	:	1972893162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERARI E FERNANDEZ CASTRO LCSW

Provider Business Mailing Address
First Line	:	111 N. WABASH AVE.
Second Line	:	SUITE 2012
City	:	CHICAGO
State	:	IL
Zip	:	60602
Country	:	US
Telephone Number	:	773-234-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N. WABASH AVE.
Second Line	:	SUITE 2012
City	:	CHICAGO
State	:	IL
Zip	:	60602
Country	:	US
Telephone Number	:	773-234-7246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2011
Last Update Date	:	02/01/2019

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