Provider Demographics
NPI:1285658732
Name:CASTELLANI, JODIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JODIE
Middle Name:
Last Name:CASTELLANI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 BAYFIELD PKWY # 136
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7597
Mailing Address - Country:US
Mailing Address - Phone:704-651-9569
Mailing Address - Fax:704-787-9672
Practice Address - Street 1:7655 BRUTON SMITH BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-0148
Practice Address - Country:US
Practice Address - Phone:704-651-9569
Practice Address - Fax:704-787-9672
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2283103TC0700X
NC3657103TC0700X
103TF0200X
NC103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic