Provider Demographics
NPI:1538768940
Name:MARINO CASTILLO, ANA ANTONIA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:ANTONIA
Last Name:MARINO CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2336
Mailing Address - Country:US
Mailing Address - Phone:786-999-5501
Mailing Address - Fax:
Practice Address - Street 1:910 SALLY AVE N
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-5205
Practice Address - Country:US
Practice Address - Phone:786-999-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-129662106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician