Provider Demographics
NPI:1184000929
Name:CESTARO, MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CESTARO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4449 N MALDEN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5563
Mailing Address - Country:US
Mailing Address - Phone:216-235-4921
Mailing Address - Fax:
Practice Address - Street 1:446 EAST ONTARIO
Practice Address - Street 2:#7-200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-7104
Practice Address - Country:US
Practice Address - Phone:312-926-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.017486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical