Provider Demographics
NPI:1538589015
Name:CASTILLO, SUSANNA V
Entity type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:V
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SUSANNA
Other - Middle Name:V
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:7475 MITCHELL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012
Mailing Address - Country:US
Mailing Address - Phone:575-528-5075
Mailing Address - Fax:575-528-6032
Practice Address - Street 1:7475 MITCHELL CIR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-9101
Practice Address - Country:US
Practice Address - Phone:575-528-5075
Practice Address - Fax:575-528-6032
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-3384104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker