Healthcare Provider Details

I. General information

NPI: 1437591518
Provider Name (Legal Business Name): CAROLINA CASTILLO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 COURTLANDT AVE FL 3
BRONX NY
10451-5008
US

IV. Provider business mailing address

2215 43RD AVE FL 2
LONG ISLAND CITY NY
11101-5018
US

V. Phone/Fax

Practice location:
  • Phone: 718-585-2153
  • Fax: 718-585-2157
Mailing address:
  • Phone: 718-389-5100
  • Fax: 718-752-4809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005635-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: