MEDICARE: MARLEN CASTELLANO PSYD INC

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	103K00000X	Behavior Analyst
2	103T00000X	Psychologist	PY8465	FL

General Provider Information

NPI Number	:	1538516216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARLEN CASTELLANO PSYD INC

Provider Business Mailing Address
First Line	:	3131 SW 135TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6657
Country	:	US
Telephone Number	:	786-234-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 SW 135TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6657
Country	:	US
Telephone Number	:	786-234-8038
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	MARLEN CASTELLANO
Credential	:	PSYD
Telephone Number	:	786-234-8038

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	05/23/2016

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