Provider Demographics
NPI:1669284857
Name:CASTELLANOS, DENISE CAROLINA ELVIR
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:CAROLINA ELVIR
Last Name:CASTELLANOS
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 1:700 SW 78TH AVE APT 1011
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3380
Mailing Address - Country:US
Mailing Address - Phone:786-395-0504
Mailing Address - Fax:
Practice Address - Street 1:2853 EXECUTIVE PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3656
Practice Address - Country:US
Practice Address - Phone:954-800-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH27073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health