MEDICARE: CHRISTINE L CASTILLO PH.D.

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	103G00000X	Clinical Neuropsychologist	33096	TX

General Provider Information

NPI Number	:	1568533818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE L CASTILLO PH.D.

Provider Business Mailing Address
First Line	:	600H EDEN ROAD
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601
Country	:	US
Telephone Number	:	717-397-1400
Fax Number	:	717-509-4066

Provider Business Practice Location Address
First Line	:	6300 HARRY HINES BLVD
Second Line	:	CHILDREN'S MEDICAL CENTER DALLAS, NEUROPSYCHOLOGY
City	:	DALLAS
State	:	TX
Zip	:	75235-5259
Country	:	US
Telephone Number	:	214-456-5872
Fax Number	:	214-456-2220

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	11/11/2015

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