Provider Demographics
NPI:1821215286
Name:JACOBS CASTANO, TERESA J (LCSW LAT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:JACOBS CASTANO
Suffix:
Gender:F
Credentials:LCSW LAT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:J
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:502 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3704
Mailing Address - Country:US
Mailing Address - Phone:307-755-1000
Mailing Address - Fax:307-742-9717
Practice Address - Street 1:502 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3704
Practice Address - Country:US
Practice Address - Phone:307-755-1000
Practice Address - Fax:307-742-9717
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical