Provider Demographics
NPI:1316528789
Name:CASTELLANOS, MAURA KATHLEEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MAURA
Middle Name:KATHLEEN
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 PELHAM DR STE F #101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1944
Mailing Address - Country:US
Mailing Address - Phone:661-769-6677
Mailing Address - Fax:
Practice Address - Street 1:8 LAVINGTON CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1944
Practice Address - Country:US
Practice Address - Phone:661-769-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32123103TC0700X
SC1693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical