Provider Demographics
NPI:1962839241
Name:CASTILE, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:CASTILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 LAKE FISCHER BLVD
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-5203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9314 LAKE FISCHER BLVD
Practice Address - Street 2:
Practice Address - City:GOTHA
Practice Address - State:FL
Practice Address - Zip Code:34734-5203
Practice Address - Country:US
Practice Address - Phone:407-592-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00652600Medicaid