Provider Demographics
NPI:1093051526
Name:MATASCASTILLO, HECTOR RENE (MSW, LICSW, LSSW)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:RENE
Last Name:MATASCASTILLO
Suffix:
Gender:M
Credentials:MSW, LICSW, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 160TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8348
Mailing Address - Country:US
Mailing Address - Phone:952-898-1133
Mailing Address - Fax:952-435-6797
Practice Address - Street 1:7580 160TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8348
Practice Address - Country:US
Practice Address - Phone:952-898-1133
Practice Address - Fax:952-435-6797
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4651871041S0200X
MN203981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool