Provider Demographics
NPI:1720301328
Name:IGLESIAS, CASSIA M (LCSW)
Entity Type:Individual
Prefix:
First Name:CASSIA
Middle Name:M
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASSIA
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8943 E DELAWARE PKWY
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3204
Mailing Address - Country:US
Mailing Address - Phone:708-986-0055
Mailing Address - Fax:708-249-0045
Practice Address - Street 1:8943 E DELAWARE PKWY
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3204
Practice Address - Country:US
Practice Address - Phone:708-986-0055
Practice Address - Fax:708-249-0045
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490139621041C0700X
IL149.0139622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
F400096688Medicare PIN