| Teresa Jacobs-castano Pc | |
|
502 S 4th St Laramie WY 82070-3704 | |
| (307) 755-1000 | |
| (307) 742-9717 |
| Full Name | Teresa Jacobs-castano Pc |
|---|---|
| Speciality | Social Worker |
| Location | 502 S 4th St, Laramie, Wyoming |
| Authorized Official Name and Position | Teresa Jacobs-castano (OWNER) |
| Authorized Official Contact | 3077551000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Teresa Jacobs-castano Pc 502 S 4th St Laramie WY 82070-3704 Ph: (307) 755-1000 | Teresa Jacobs-castano Pc 502 S 4th St Laramie WY 82070-3704 Ph: (307) 755-1000 |
| NPI Number | 1164650917 |
|---|---|
| Provider Enumeration Date | 06/30/2009 |
| Last Update Date | 03/21/2019 |
| Medicare PECOS PAC ID | 0244377323 |
|---|---|
| Medicare Enrollment ID | O20091021000772 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164650917 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW 176 (Wyoming) | Primary |
| Provider Name | Teresa Jacobs Castano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821215286 PECOS PAC ID: 6002953189 Enrollment ID: I20091021000726 |
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