=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154964948
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL DECASTRO, MFT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2019
-----------------------------------------------------
Last Update Date | 10/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 NORTH ST STE 115
-----------------------------------------------------
City | DANBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06810-5626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-794-4714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 GARELLA RD
-----------------------------------------------------
City | BETHEL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06801-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-994-0475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DANIEL DECASTRO
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 203-794-4714
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------