MEDICARE: GRACE MARIE CASTILLO 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	LW00009219	WA
2	1041C0700X	Clinical Social Worker	25468	TX

General Provider Information

NPI Number	:	1588851224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE MARIE CASTILLO LCSW

Provider Business Mailing Address
First Line	:	1311 CHISHOLM TRL STE 301
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2969
Country	:	US
Telephone Number	:	512-593-1332
Fax Number	:	512-248-9833

Provider Business Practice Location Address
First Line	:	1311 CHISHOLM TRL STE 301
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2969
Country	:	US
Telephone Number	:	512-593-1332
Fax Number	:	512-248-9833

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

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	11/17/2017

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Directions to “ GRACE MARIE CASTILLO LCSW” Practice Location

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