Healthcare Provider Details

I. General information

NPI: 1073561429
Provider Name (Legal Business Name): MAYELA LLAURADOR-CASTILLO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WAHOO AVE
GROTON CT
06349-2324
US

IV. Provider business mailing address

BALCONES DE MONTE REAL APT. C-1905
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-4966
  • Fax:
Mailing address:
  • Phone: 787-762-3548
  • Fax: 787-762-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1446
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: