Provider Demographics
NPI:1760774673
Name:CASTILLO, BRANDY LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LEE
Last Name:CASTILLO
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 1:27 CRUCES LOOP
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-0015
Mailing Address - Country:US
Mailing Address - Phone:505-967-9975
Mailing Address - Fax:
Practice Address - Street 1:1300 EAST RIVER ROAD
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002
Practice Address - Country:US
Practice Address - Phone:505-312-0040
Practice Address - Fax:505-213-0066
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-073621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical