Provider Demographics
NPI:1104630631
Name:CASTANEDA, MEGAN (MSW, LSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6619 BROTHERHOOD WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-4226
Mailing Address - Country:US
Mailing Address - Phone:765-462-2374
Mailing Address - Fax:
Practice Address - Street 1:703 W PARK ST
Practice Address - Street 2:
Practice Address - City:CAYUGA
Practice Address - State:IN
Practice Address - Zip Code:47928-8207
Practice Address - Country:US
Practice Address - Phone:765-492-9042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011408A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker