Provider Demographics
NPI:1093932121
Name:CASTANEDA, MARTHA J (MSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 E BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-4041
Mailing Address - Country:US
Mailing Address - Phone:602-254-4827
Mailing Address - Fax:
Practice Address - Street 1:1046 E BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-4041
Practice Address - Country:US
Practice Address - Phone:602-254-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-114411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical