Healthcare Provider Details

I. General information

NPI: 1427801901
Provider Name (Legal Business Name): SIVIA MARIA CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12811 KENWOOD LN STE 213
FORT MYERS FL
33907-5648
US

IV. Provider business mailing address

21568 WINDHAM RUN
ESTERO FL
33928-3264
US

V. Phone/Fax

Practice location:
  • Phone: 239-537-9646
  • Fax:
Mailing address:
  • Phone: 239-919-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: