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General NPI Number Information
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NPI Number | 1194931600
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Entity Type | Individual
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Provider Name | MARJORIE BUCHHOLZ-CASTRONOVA M.S.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 1790 W PARK AVE STE 200
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City | REDLANDS
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State | CA
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Zip | 92373-3112
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Country | US
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Telephone | 909-558-9556
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Fax |
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Provider Business Mailing Address
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Address Line | 1092 MOONLIT OASIS LN UNIT 103
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City | HENDERSON
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State | NV
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Zip | 89002-0625
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Country | US
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Telephone | 170-248-0417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 116112
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0832
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License Number State | NV
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