Healthcare Provider Details

I. General information

NPI: 1609266188
Provider Name (Legal Business Name): PELLIE CASTELLANO LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL AVE
WESTMINSTER MD
21157-5726
US

IV. Provider business mailing address

535 OLD WESTMINSTER PIKE SUITE 102
WESTMINSTER MD
21157-6267
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15482
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: