Provider Demographics
NPI:1508142480
Name:CASTELO, MARIO ADAN
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ADAN
Last Name:CASTELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5996
Mailing Address - Country:US
Mailing Address - Phone:312-620-8836
Mailing Address - Fax:
Practice Address - Street 1:4660 S EASTERN AVE
Practice Address - Street 2:200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6137
Practice Address - Country:US
Practice Address - Phone:702-451-7542
Practice Address - Fax:702-450-4239
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1074571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical