Healthcare Provider Details

I. General information

NPI: 1073426003
Provider Name (Legal Business Name): KARLY CASTILLO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N PROVIDENCE RD REAR ENTRANCE
MEDIA PA
19063
US

IV. Provider business mailing address

511 N PROVIDENCE RD REAR ENTRANCE
MEDIA PA
19063
US

V. Phone/Fax

Practice location:
  • Phone: 484-442-0073
  • Fax: 484-205-4950
Mailing address:
  • Phone: 484-442-0073
  • Fax: 484-205-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002094
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: