Provider Demographics
NPI:1467799908
Name:CANTU, CARLOS P (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:P
Last Name:CANTU
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 1:3017 S LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4549
Mailing Address - Country:US
Mailing Address - Phone:773-707-9775
Mailing Address - Fax:312-957-6252
Practice Address - Street 1:3934 W 26TH ST STE 204
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3743
Practice Address - Country:US
Practice Address - Phone:773-707-9775
Practice Address - Fax:312-957-6252
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0155331041C0700X
IL14677999081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.015533OtherLICENSED NO.