Provider Demographics
NPI:1417011230
Name:CASTRO, RAUL (LCPC)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3817
Mailing Address - Country:US
Mailing Address - Phone:708-772-1117
Mailing Address - Fax:
Practice Address - Street 1:3339 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3817
Practice Address - Country:US
Practice Address - Phone:708-772-1117
Practice Address - Fax:888-223-5281
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional