Provider Demographics
NPI:1659316693
Name:CASTILLO, MABEL (LCSW, PA)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LCSW, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8137
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-0119
Mailing Address - Country:US
Mailing Address - Phone:863-452-1325
Mailing Address - Fax:863-452-1385
Practice Address - Street 1:1753 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9504
Practice Address - Country:US
Practice Address - Phone:863-452-1325
Practice Address - Fax:863-452-1385
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW53151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ090GOtherBC BS OF FL
FLZ090GOtherBC BS OF FL
E8204Medicare PIN