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General NPI Number Information
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NPI Number | 1225617772
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Entity Type | Individual
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Provider Name | JORDAN CASTRO LMSW, CASAC-2
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Gender | Male
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 3034 GOMER ST
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City | YORKTOWN HEIGHTS
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State | NY
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Zip | 10598-2724
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Country | US
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Telephone | 917-715-2841
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Fax |
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Provider Business Mailing Address
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Address Line | 3034 GOMER ST
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City | YORKTOWN HEIGHTS
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State | NY
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Zip | 10598-2724
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Country | US
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Telephone | 917-715-2841
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 30762
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 112056
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 112056
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License Number State | NY
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