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NPI Code Detail

MEDICARE: HEATHER LYNN CASTONGUAY LCSW

MEDICARE: HEATHER LYNN CASTONGUAY LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCSW-17494AZ

General Provider Information

NPI Number : 1033687314
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER LYNN CASTONGUAY LCSW
Provider Business Mailing Address
First Line : 14910 W DREYFUS ST
Second Line :
City : SURPRISE
State : AZ
Zip : 85379-4284
Country : US
Telephone Number : 623-606-9296
Fax Number :
Provider Business Practice Location Address
First Line : 6677 W THUNDERBIRD RD STE A124
Second Line :
City : GLENDALE
State : AZ
Zip : 85306-3710
Country : US
Telephone Number : 480-882-4545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2018
Last Update Date : 11/05/2018

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