Healthcare Provider Details

I. General information

NPI: 1831689009
Provider Name (Legal Business Name): ELISA M CASTILLO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 LAFAYETTE STREET
SALEM MA
01970
US

IV. Provider business mailing address

352 LAFAYETTE ST
SALEM MA
01970-5348
US

V. Phone/Fax

Practice location:
  • Phone: 978-542-6420
  • Fax:
Mailing address:
  • Phone: 978-542-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8227
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: