Healthcare Provider Details

I. General information

NPI: 1508472911
Provider Name (Legal Business Name): TRINIDAD J CASTILLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8856 ARLINGTON AVE
RIVERSIDE CA
92503-1365
US

IV. Provider business mailing address

23311 DRACAEA AVE
MORENO VALLEY CA
92553-3201
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax:
Mailing address:
  • Phone: 323-586-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number95536
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: