Provider Demographics
NPI:1205650165
Name:CASTLEBERRY, KRISTA KAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:KAY
Last Name:CASTLEBERRY
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 1:221 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2739
Mailing Address - Country:US
Mailing Address - Phone:212-866-5103
Mailing Address - Fax:
Practice Address - Street 1:221 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2739
Practice Address - Country:US
Practice Address - Phone:212-866-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW77691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical