Provider Demographics
NPI:1326182502
Name:CASTELLANO, LISA M
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15277 COPPER LOOP
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34603-5021
Mailing Address - Country:US
Mailing Address - Phone:352-277-3401
Mailing Address - Fax:352-277-3402
Practice Address - Street 1:15277 COPPER LOOP
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-5021
Practice Address - Country:US
Practice Address - Phone:352-277-3401
Practice Address - Fax:352-277-3402
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist