Provider Demographics
NPI:1053673327
Name:CASTELLANOS PARETA, TAIMI
Entity Type:Individual
Prefix:
First Name:TAIMI
Middle Name:
Last Name:CASTELLANOS PARETA
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 1:18119 NW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6556
Mailing Address - Country:US
Mailing Address - Phone:786-315-0949
Mailing Address - Fax:
Practice Address - Street 1:18119 NW 90TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6556
Practice Address - Country:US
Practice Address - Phone:786-315-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLMH21587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker