Healthcare Provider Details

I. General information

NPI: 1134899453
Provider Name (Legal Business Name): LISA ROSE CASTILLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ROSE HARWOOD ACSW

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 03/26/2023
Certification Date: 03/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 BECK AVE
FAIRFIELD CA
94533-4440
US

IV. Provider business mailing address

2701 DEL PASO ROAD SUITE 130 #247
SACRAMENTO CA
95835
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-6570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: