Provider Demographics
NPI:1457349904
Name:CASTALDI, MICHAEL LOUIS (LICSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LOUIS
Last Name:CASTALDI
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHAMPLIN PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2810
Mailing Address - Country:US
Mailing Address - Phone:401-847-8040
Mailing Address - Fax:401-846-9933
Practice Address - Street 1:82 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5276
Practice Address - Country:US
Practice Address - Phone:401-847-8040
Practice Address - Fax:401-846-9933
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIIISW000571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMC00299Medicaid