Provider Demographics
NPI:1881249621
Name:CASTANEDA, SONIA (MSW, LSW)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-8359
Mailing Address - Country:US
Mailing Address - Phone:815-354-2012
Mailing Address - Fax:
Practice Address - Street 1:4920 E STATE ST STE B
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2272
Practice Address - Country:US
Practice Address - Phone:815-227-9002
Practice Address - Fax:815-227-9070
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150103863104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker