Provider Demographics
NPI:1588179642
Name:CASTELLANOS MILLER, RAQUEL TERESA (LCSW)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:TERESA
Last Name:CASTELLANOS MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 NICHOLL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3919
Mailing Address - Country:US
Mailing Address - Phone:406-370-0938
Mailing Address - Fax:
Practice Address - Street 1:80 NICHOLL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3919
Practice Address - Country:US
Practice Address - Phone:406-370-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS-941461041C0700X
MTBBH-LCSW-LIC-272451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical