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General NPI Number Information
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NPI Number | 1225459530
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Entity Type | Individual
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Provider Name | RAYMOND CASTILLEJA JR. LCSW-S
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Gender | Male
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Dates
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Enumeration Date | 01/04/2014
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 4004 WORTH ST STE 200
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City | DALLAS
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State | TX
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Zip | 75246-1640
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Country | US
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Telephone | 469-802-2468
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Fax |
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Provider Business Mailing Address
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Address Line | 16127 AMBERWOOD RD
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City | DALLAS
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State | TX
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Zip | 75248-2962
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Country | US
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Telephone | 214-498-9398
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 56285
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 56285
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License Number State | TX
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