Provider Demographics
NPI:1841874062
Name:CASTRO, ELISA MARTINEZ (LMSW)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:MARTINEZ
Last Name:CASTRO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6751 W INDIAN SCHOOL RD APT 1153
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-6211
Mailing Address - Country:US
Mailing Address - Phone:623-640-6878
Mailing Address - Fax:
Practice Address - Street 1:6751 W INDIAN SCHOOL RD APT 1153
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-6211
Practice Address - Country:US
Practice Address - Phone:623-640-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-19444104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker