Provider Demographics
NPI:1477638906
Name:CASTENELL, MICHAEL LOUIS (DSW, LISW)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LOUIS
Last Name:CASTENELL
Suffix:
Gender:M
Credentials:DSW, LISW
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:CASTENELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW, LLC
Mailing Address - Street 1:209 N LORENA AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8446
Mailing Address - Country:US
Mailing Address - Phone:505-324-1791
Mailing Address - Fax:505-324-8262
Practice Address - Street 1:209 N LORENA AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8446
Practice Address - Country:US
Practice Address - Phone:505-324-1791
Practice Address - Fax:505-324-8262
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-00341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97686Medicaid
NMNM100582Medicaid