Healthcare Provider Details

I. General information

NPI: 1457682171
Provider Name (Legal Business Name): MANUEL CASTILLO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 N 83RD AVE STE 104
PEORIA AZ
85382-5820
US

IV. Provider business mailing address

3033 N CENTRAL AVE STE 145
PHOENIX AZ
85012-2808
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-2273
  • Fax: 623-505-3272
Mailing address:
  • Phone: 623-583-3001
  • Fax: 623-974-6721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW-12810
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: