Provider Demographics
NPI:1902954431
Name:CASTILLO, LISA M (MS, CGC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 W SHERIDAN RD APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3243
Mailing Address - Country:US
Mailing Address - Phone:773-248-1495
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE # MC6088
Practice Address - Street 2:UNIVERSITY OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-4310
Practice Address - Fax:773-702-2681
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS