MEDICARE: CASTLEBERRY & ASSOCIATES, 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	103TC0700X	Clinical Psychologist	2774	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972675437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLEBERRY & ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 637
Second Line	:
City	:	NEWELL
State	:	NC
Zip	:	28126-0637
Country	:	US
Telephone Number	:	980-253-6150
Fax Number	:

Provider Business Practice Location Address
First Line	:	941 FOXBOROUGH RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5765
Country	:	US
Telephone Number	:	980-253-6150
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	ELEANOR CASTLEBERRY
Credential	:	PH.D.
Telephone Number	:	980-253-6150

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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