Provider Demographics
NPI:1518127471
Name:CASTELLANOS, PERCY RAYNIER (BA)
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:RAYNIER
Last Name:CASTELLANOS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 TELEGRAPH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1984
Mailing Address - Country:US
Mailing Address - Phone:510-924-4838
Mailing Address - Fax:
Practice Address - Street 1:3101 TELEGRAPH AVE FL 2
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1984
Practice Address - Country:US
Practice Address - Phone:510-924-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW31571104100000X
CALCSW 646711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker