Provider Demographics
NPI:1538520135
Name:CASTRO, TINA (LCSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:CASTRO
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 1:1800 CENTURY PARK E STE 614
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-1501
Mailing Address - Country:US
Mailing Address - Phone:310-701-9930
Mailing Address - Fax:
Practice Address - Street 1:1800 CENTURY PARK E STE 614
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-1501
Practice Address - Country:US
Practice Address - Phone:310-701-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW67507104100000X
CA952861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker