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General NPI Number Information
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NPI Number | 1407333800
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Entity Type | Organization
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Legal Business Name | THE PSYCHOLOGY OFFICE OF DR. CONNIE JASMINE CASTRO PLLC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 5392 62ND ST
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City | MASPETH
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State | NY
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Zip | 11378
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Country | US
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Telephone | 917-991-1615
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Fax |
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Provider Business Mailing Address
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Address Line | 5392 62ND ST
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City | MASPETH
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State | NY
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Zip | 11378-1233
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Country | US
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Telephone | 917-991-1615
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | CONNIE JASMINE CASTRO
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Credential | PSY.D.
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Telephone | 917-991-1615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 022577
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License Number State | NY
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