Provider Demographics
NPI: | 1639239742 |
---|---|
Name: | CASTELLINI, JANET D (PSYD, APRN,BC) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JANET |
Middle Name: | D |
Last Name: | CASTELLINI |
Suffix: | |
Gender: | F |
Credentials: | PSYD, APRN,BC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3554 RAYMAR DR |
Mailing Address - Street 2: | |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45208-1560 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-871-0777 |
Mailing Address - Fax: | 513-793-1862 |
Practice Address - Street 1: | 9403 KENWOOD RD |
Practice Address - Street 2: | SUITE C107 |
Practice Address - City: | CINCINNATI |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45242-6895 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-793-1715 |
Practice Address - Fax: | 513-793-1862 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-12-11 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 5965 | 103TC0700X, 103T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
Not Answered | 103T00000X | Behavioral Health & Social Service Providers | Psychologist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2486644 | Medicaid | |
OH | 2486644 | Medicaid |