Provider Demographics
NPI:1134828064
Name:CASTILLO, PALOMA K (LICSW)
Entity type:Individual
Prefix:
First Name:PALOMA
Middle Name:K
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:PALOMA
Other - Middle Name:K
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5100 OLD BIRMINGHAM HWY APT 812
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-4661
Mailing Address - Country:US
Mailing Address - Phone:205-412-2725
Mailing Address - Fax:
Practice Address - Street 1:4124 WATERMELON RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5251
Practice Address - Country:US
Practice Address - Phone:205-454-1897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5278C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical