Provider Demographics
NPI:1487871406
Name:CASTIGLIA, STEPHANIE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:CASTIGLIA
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 1:12564 189TH CT N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-3753
Mailing Address - Country:US
Mailing Address - Phone:561-745-5403
Mailing Address - Fax:
Practice Address - Street 1:609 N HEPBURN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5015
Practice Address - Country:US
Practice Address - Phone:561-745-5403
Practice Address - Fax:561-745-5406
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6480103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK370Medicare PIN