Healthcare Provider Details

I. General information

NPI: 1437511771
Provider Name (Legal Business Name): RYAN CASTRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 IKEA DR
WESTAMPTON NJ
08060-5115
US

IV. Provider business mailing address

25 IKEA DR
WESTAMPTON NJ
08060-5115
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-9339
  • Fax:
Mailing address:
  • Phone: 609-267-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: