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General NPI Number Information
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NPI Number | 1689950693
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Entity Type | Individual
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Provider Name | ADAM CASTLEBERRY PSY.D
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Gender | Male
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 1013 EGRET WAY
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City | LAKE PARK
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State | GA
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Zip | 31636-2759
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Country | US
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Telephone | 292-588-1985
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Fax |
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Provider Business Mailing Address
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Address Line | 20 RESEARCH PKWY
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City | OLD SAYBROOK
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State | CT
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Zip | 06475-4214
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Country | US
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Telephone | 800-370-3651
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Fax | 860-510-0020
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY003724
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8652
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License Number State | FL
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