Provider Demographics
NPI:1821177817
Name:CASTANEDA, VIVIAN (LCSW)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:CASTANEDA
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 1:20651 GOLDEN SPRINGS DR STE F #3100
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3866
Mailing Address - Country:US
Mailing Address - Phone:323-591-4884
Mailing Address - Fax:
Practice Address - Street 1:3211 LETICIA DR
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6223
Practice Address - Country:US
Practice Address - Phone:323-591-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 18403104100000X
CA284711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker