Provider Demographics
NPI:1760046825
Name:CASTIBLANCO, MELANIE ALICIA (MT-BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ALICIA
Last Name:CASTIBLANCO
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-9276
Mailing Address - Country:US
Mailing Address - Phone:570-350-3160
Mailing Address - Fax:
Practice Address - Street 1:3437 MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-2905
Practice Address - Country:US
Practice Address - Phone:610-442-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist