1770818676 NPI number — MS. ADELA ELVIRA CASTILLO PSY.D.

Table of content: MS. ADELA ELVIRA CASTILLO PSY.D. (NPI 1770818676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770818676 NPI number — MS. ADELA ELVIRA CASTILLO PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
ADELA
Provider Middle Name:
ELVIRA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770818676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10-24 49TH AVENUE
Provider Second Line Business Mailing Address:
LONG ISLAND CITY, BIRCH FAMILY SERVICES, WESTERN QUEENS
Provider Business Mailing Address City Name:
NEW YORK CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-786-1104
Provider Business Mailing Address Fax Number:
718-391-0040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10-24 49TH AVENUE
Provider Second Line Business Practice Location Address:
LONG ISLAND CITY, BIRCH FAMILY SERVICES, WESTERN QUEENS
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-786-1104
Provider Business Practice Location Address Fax Number:
718-391-0040
Provider Enumeration Date:
10/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  639679951 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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