Healthcare Provider Details

I. General information

NPI: 1871408559
Provider Name (Legal Business Name): KARLA VASQUEZ CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 GREGORY AVE
PASSAIC NJ
07055-4856
US

IV. Provider business mailing address

325 WESTERVELT PL FL 1
LODI NJ
07644-1214
US

V. Phone/Fax

Practice location:
  • Phone: 973-928-7244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00991600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: