Healthcare Provider Details

I. General information

NPI: 1437971496
Provider Name (Legal Business Name): MELISSA CASTILLO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 GOLF COURSE RD NW
ALBUQUERQUE NM
87114-5775
US

IV. Provider business mailing address

4476 SNOW HEIGHTS CIR SE
RIO RANCHO NM
87124-5928
US

V. Phone/Fax

Practice location:
  • Phone: 505-305-0902
  • Fax:
Mailing address:
  • Phone: 505-364-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0323
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: