Provider Demographics
NPI:1366858839
Name:CASTILLO, MARITZA (MSW, L CSW)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MSW, L CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 POPLAR BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3063
Mailing Address - Country:US
Mailing Address - Phone:626-484-1770
Mailing Address - Fax:
Practice Address - Street 1:2509 POPLAR BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3063
Practice Address - Country:US
Practice Address - Phone:626-484-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-06
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW61789104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker