MEDICARE: JEREMY RICHARD CASTANEDA 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	44SC05970600	NJ

General Provider Information

NPI Number	:	1578155131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY RICHARD CASTANEDA LCSW

Provider Business Mailing Address
First Line	:	18 GARDEN CT S
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-2314
Country	:	US
Telephone Number	:	201-398-6113
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 GARDEN CT S
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-2314
Country	:	US
Telephone Number	:	201-398-6113
Fax Number	:

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

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	04/18/2022

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