MEDICARE: RAYMOND CASTILLEJA JR. LCSW-S

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	104100000X	Social Worker	56285	TX
2	1041C0700X	Clinical Social Worker	56285	TX

General Provider Information

NPI Number	:	1225459530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND CASTILLEJA JR. LCSW-S

Provider Business Mailing Address
First Line	:	16127 AMBERWOOD RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-2962
Country	:	US
Telephone Number	:	214-498-9398
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 WORTH ST STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1640
Country	:	US
Telephone Number	:	469-802-2468
Fax Number	:

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

Provider Enumeration Date	:	01/04/2014
Last Update Date	:	02/28/2023

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Directions to “ RAYMOND CASTILLEJA JR. LCSW-S” Practice Location

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