MEDICARE: MR. MICHAEL ANGELO CASTELLANA 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
1	1041C0700X	Clinical Social Worker	1018789	MA
2	1041C0700X	Clinical Social Worker	LCS 17788	CA

General Provider Information

NPI Number	:	1134209968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANGELO CASTELLANA LCSW

Provider Business Mailing Address
First Line	:	126 W SPRUCE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 KEARNY VILLA RD STE 214
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1563
Country	:	US
Telephone Number	:	619-491-0434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	02/27/2018

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