Provider Demographics
NPI:1083908529
Name:CASTILLO, MARY BETH (LISW)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:DOBROVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:24075 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5846
Mailing Address - Country:US
Mailing Address - Phone:216-292-3999
Mailing Address - Fax:216-378-2785
Practice Address - Street 1:24075 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5846
Practice Address - Country:US
Practice Address - Phone:216-292-3333
Practice Address - Fax:216-378-2785
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI10000841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI1000084OtherLICENSE NUMBER