Healthcare Provider Details

I. General information

NPI: 1912943432
Provider Name (Legal Business Name): DIANE BEHNKE CASTILLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 MEDICAL DR 6300
SAN ANTONIO TX
78229-5640
US

IV. Provider business mailing address

4242 MEDICAL DR SUITE 6300
SAN ANTONIO TX
78229-5640
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-8400
  • Fax: 210-614-8165
Mailing address:
  • Phone: 210-614-8400
  • Fax: 210-614-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05499
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: