MEDICARE: LISA M CASTELLANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326182502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M CASTELLANO

Provider Business Mailing Address
First Line	:	15277 COPPER LOOP
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34603-5021
Country	:	US
Telephone Number	:	352-277-3401
Fax Number	:	352-277-3402

Provider Business Practice Location Address
First Line	:	15277 COPPER LOOP
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-5021
Country	:	US
Telephone Number	:	352-277-3401
Fax Number	:	352-277-3402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	09/11/2025

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Directions to “ LISA M CASTELLANO ” Practice Location

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