Healthcare Provider Details

I. General information

NPI: 1659316693
Provider Name (Legal Business Name): MABEL CASTILLO LCSW, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 US HIGHWAY 27 N
AVON PARK FL
33825-9504
US

IV. Provider business mailing address

PO BOX 8137
SEBRING FL
33872-0119
US

V. Phone/Fax

Practice location:
  • Phone: 863-452-1325
  • Fax: 863-452-1385
Mailing address:
  • Phone: 863-452-1325
  • Fax: 863-452-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: