Healthcare Provider Details

I. General information

NPI: 1427221597
Provider Name (Legal Business Name): CARLOS Y CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 BLUE HILL AVE
DORCHESTER CENTER MA
02124-2902
US

IV. Provider business mailing address

197 HAMILTON ST
DORCHESTER MA
02122-1504
US

V. Phone/Fax

Practice location:
  • Phone: 617-822-0829
  • Fax: 617-825-7804
Mailing address:
  • Phone: 617-230-7323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: