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General NPI Number Information
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NPI Number | 1669211132
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Entity Type | Individual
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Provider Name | LOUIS CASTELLANO LAC
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Gender | Male
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 830 MORRIS TURNPIKE SUITE 405
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City | SHORT HILLS
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State | NJ
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Zip | 07078
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Country | US
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Telephone | 973-544-8617
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Fax |
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Provider Business Mailing Address
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Address Line | 11 THACKERY DR
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City | ROSELAND
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State | NJ
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Zip | 07068
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Country | US
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Telephone | 973-545-6931
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00772600
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License Number State | NJ
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