Provider Demographics
NPI:1235632514
Name:CASTANEDA, MADELINE MARLENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:MARLENE
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:MARLENE
Other - Last Name:VELAZQUEZ-MARMOLEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6799 ALVARADO RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5220
Mailing Address - Country:US
Mailing Address - Phone:619-215-4327
Mailing Address - Fax:
Practice Address - Street 1:1679 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5212
Practice Address - Country:US
Practice Address - Phone:619-441-1907
Practice Address - Fax:619-441-1908
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110295101YM0800X
CALCSW1002911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health