Provider Demographics
NPI:1811531809
Name:CASTANO MANN, ALYSSA (MSW LCSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:CASTANO MANN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7043 CORBITT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2448
Mailing Address - Country:US
Mailing Address - Phone:314-669-6396
Mailing Address - Fax:
Practice Address - Street 1:9378 OLIVE BLVD STE 104A
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3222
Practice Address - Country:US
Practice Address - Phone:314-669-6396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018013137104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker