Provider Demographics
NPI:1780198986
Name:CASTANO BISHOP, MARIANNE S (EDD, MED, MS, LMHCA)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:S
Last Name:CASTANO BISHOP
Suffix:
Gender:F
Credentials:EDD, MED, MS, LMHCA
Other - Prefix:DR
Other - First Name:MARIANNE
Other - Middle Name:CASTANO
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD, MED, MS, LMHCA
Mailing Address - Street 1:1001 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-1821
Mailing Address - Country:US
Mailing Address - Phone:781-367-7080
Mailing Address - Fax:
Practice Address - Street 1:3516 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3034
Practice Address - Country:US
Practice Address - Phone:574-287-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000328A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health