Healthcare Provider Details

I. General information

NPI: 1538516216
Provider Name (Legal Business Name): MARLEN CASTELLANO PSYD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 SW 135TH AVE
MIAMI FL
33175-6657
US

IV. Provider business mailing address

3131 SW 135TH AVE
MIAMI FL
33175-6657
US

V. Phone/Fax

Practice location:
  • Phone: 786-234-8038
  • Fax:
Mailing address:
  • Phone: 786-234-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8465
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARLEN CASTELLANO
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 786-234-8038