Provider Demographics
NPI:1184304396
Name:CASTILLO MIRANDA, ANGIE PATRICIA (LCSW-A)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:PATRICIA
Last Name:CASTILLO MIRANDA
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 GRANVILLE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-2007
Mailing Address - Country:US
Mailing Address - Phone:978-788-4129
Mailing Address - Fax:
Practice Address - Street 1:1529 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-2007
Practice Address - Country:US
Practice Address - Phone:978-788-4129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0193001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical