Provider Demographics
NPI:1760090906
Name:CASTELLANO, MARCOS ELVIRES (LCSW)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:ELVIRES
Last Name:CASTELLANO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 COUNTY ROAD 19
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-9457
Mailing Address - Country:US
Mailing Address - Phone:505-929-4729
Mailing Address - Fax:
Practice Address - Street 1:320 OSUNA RD NE STE H4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5955
Practice Address - Country:US
Practice Address - Phone:505-345-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-12641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical