Basic Information
| Provider Information | |||||||||
| NPI: | 1659008480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTELLANO | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 575021 | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113575021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473426633 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9114 37TH AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113727920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187791831 | ||||||||
| FaxNumber: | 3476124126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2022 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 115472 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.