MEDICARE: DR. JILL SARIE CASTRO PSY.D., LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301013351	MI

General Provider Information

NPI Number	:	1124138300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL SARIE CASTRO PSY.D., LLP

Provider Business Mailing Address
First Line	:	26105 ORCHARD LAKE RD
Second Line	:	SUITE 204
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4576
Country	:	US
Telephone Number	:	248-229-8388
Fax Number	:

Provider Business Practice Location Address
First Line	:	26105 ORCHARD LAKE RD
Second Line	:	SUITE 204
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4576
Country	:	US
Telephone Number	:	248-229-8388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	10/03/2012

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