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General NPI Number Information
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NPI Number | 1750633541
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Entity Type | Organization
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Legal Business Name | CASTELO NEUROPSYCHOLOGY
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 701 E HAMPDEN AVE SUITE 415
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2736
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Country | US
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Telephone | 617-290-3475
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Fax |
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Provider Business Mailing Address
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Address Line | 701 E HAMPDEN AVE SUITE 415
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2736
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Country | US
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Telephone | 617-290-3475
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Fax |
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Authorized Official
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Title or Position | CLINICAL NEUROPSYCHOLOGIST
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Name | DR. JESSICA MIMI CASTELO
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Credential | PH.D.
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Telephone | 617-290-3475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 3756
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License Number State | CO
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