Basic Information
Provider Information
NPI: 1306932181
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASTRO
FirstName: ARACELIS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: BOX 653
Address2:  
City: LARES
State: PR
PostalCode: 00669
CountryCode: US
TelephoneNumber: 7879952700
FaxNumber: 7879952706
Practice Location
Address1: #435 HOSTOS AVE.
Address2:  
City: HATO REY
State: PR
PostalCode: 00918
CountryCode: US
TelephoneNumber: 7879952700
FaxNumber: 7879952706
Other Information
ProviderEnumerationDate: 10/05/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X7251PRY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


Home