Provider Demographics
NPI:1447542345
Name:CASTRO, ANTONIO (MSW)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:CASTRO
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1798
Mailing Address - Country:US
Mailing Address - Phone:909-580-6694
Mailing Address - Fax:909-370-1025
Practice Address - Street 1:1212 VALENCIA DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1798
Practice Address - Country:US
Practice Address - Phone:909-580-6694
Practice Address - Fax:909-370-1025
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612991041C0700X, 101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor