Healthcare Provider Details

I. General information

NPI: 1659830586
Provider Name (Legal Business Name): BREANNA M CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W WOODLAND AVE
YOUNGSTOWN OH
44502-1866
US

IV. Provider business mailing address

209 W WOODLAND AVE
YOUNGSTOWN OH
44502-1866
US

V. Phone/Fax

Practice location:
  • Phone: 330-787-9180
  • Fax: 234-254-8413
Mailing address:
  • Phone: 330-787-9180
  • Fax: 234-254-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number0202708
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: