Provider Demographics
NPI:1700537271
Name:CASTILLO, LAURA (LSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1840
Mailing Address - Country:US
Mailing Address - Phone:248-613-5550
Mailing Address - Fax:
Practice Address - Street 1:1011 LAKE ST STE 405
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1129
Practice Address - Country:US
Practice Address - Phone:312-659-4718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1048281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical