Provider Demographics
NPI:1063792281
Name:CASTILLO, JOSEPH RAFAEL (LCPC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RAFAEL
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8232 NILES CENTER RD
Mailing Address - Street 2:APT. 316
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-5203
Mailing Address - Country:US
Mailing Address - Phone:773-236-2123
Mailing Address - Fax:
Practice Address - Street 1:8232 NILES CENTER RD
Practice Address - Street 2:APT. 316
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-5203
Practice Address - Country:US
Practice Address - Phone:773-236-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional