Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 20544 | MD |
NPI | 1003585944 |
---|---|
Provider Name | Diana Castellon |
First Address | Olney, MD 20832-2277 |
Second Address | Olney, MD 20832-2277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2021 |
Last Update Date | 13/09/2021 |