Provider Demographics
NPI:1275106395
Name:CASTELLANO, BRIANNA NOEL
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NOEL
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:NOEL
Other - Last Name:CASTELLANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4837
Mailing Address - Country:US
Mailing Address - Phone:907-347-7741
Mailing Address - Fax:
Practice Address - Street 1:2550 LAWLOR RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-6458
Practice Address - Country:US
Practice Address - Phone:907-347-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)