Provider Demographics
NPI:1891538575
Name:CASTELLANOS, ANTHONY (MA, LEP)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:CASTELLANOS
Suffix:
Gender:M
Credentials:MA, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12329 MARBEL AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2642
Mailing Address - Country:US
Mailing Address - Phone:310-430-4222
Mailing Address - Fax:
Practice Address - Street 1:10409 LAKEWOOD BLVD UNIT 1353
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-1219
Practice Address - Country:US
Practice Address - Phone:310-430-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4450103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist