Provider Demographics
NPI:1386120590
Name:CASTILLO, JOE A (LMSW, CCSOTS)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:A
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:LMSW, CCSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 S MAIN ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3124
Mailing Address - Country:US
Mailing Address - Phone:575-527-0614
Mailing Address - Fax:575-541-4062
Practice Address - Street 1:1605 S MAIN ST BLDG A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3124
Practice Address - Country:US
Practice Address - Phone:575-527-0614
Practice Address - Fax:575-541-4062
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07442104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM$$$$$$$$$Medicaid