Healthcare Provider Details

I. General information

NPI: 1558059568
Provider Name (Legal Business Name): JUAN ZURITA-CASTILLA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 WHALLEY AVE STE 300
NEW HAVEN CT
06511-3019
US

IV. Provider business mailing address

43 MERRITT ST
HAMDEN CT
06517-3921
US

V. Phone/Fax

Practice location:
  • Phone: 203-285-6475
  • Fax:
Mailing address:
  • Phone: 203-645-8913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12976
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: