Provider Demographics
NPI:1598009730
Name:MOSSBERG, ARIELLE CARLA CASTRO
Entity type:Individual
Prefix:
First Name:ARIELLE
Middle Name:CARLA CASTRO
Last Name:MOSSBERG
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 1:22 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1635
Mailing Address - Country:US
Mailing Address - Phone:734-934-9524
Mailing Address - Fax:
Practice Address - Street 1:22 WESTWOOD RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1635
Practice Address - Country:US
Practice Address - Phone:734-934-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health