Provider Demographics
NPI:1841729068
Name:CASTILLO, MARIELA CASTRO
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:CASTRO
Last Name: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:PO BOX 40904
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94140-0904
Mailing Address - Country:US
Mailing Address - Phone:415-970-3822
Mailing Address - Fax:
Practice Address - Street 1:3801 3RD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1409
Practice Address - Country:US
Practice Address - Phone:415-970-3800
Practice Address - Fax:415-970-3813
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA84816101YM0800X, 104100000X
CA1073251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker