MEDICARE: DR. NEIL RYAN CASTRONOVO PH.D.

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	PSYCHOLOGIST 3144	MA
2	103T00000X	Psychologist	PSYCHOLOGIST 3144	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740399666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL RYAN CASTRONOVO PH.D.

Provider Business Mailing Address
First Line	:	19 MARWOOD RD
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01602-1716
Country	:	US
Telephone Number	:	508-754-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 MARWOOD RD
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01602-1716
Country	:	US
Telephone Number	:	508-754-0393
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/20/2010

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