Provider Demographics
NPI:1356745285
Name:DECASTRO, NICHOLAS (BA)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:DECASTRO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
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Mailing Address - Street 1:3596 TAMIAMI TRL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3596 TAMIAMI TRL
Practice Address - Street 2:SUITE 205
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8263
Practice Address - Country:US
Practice Address - Phone:941-255-5900
Practice Address - Fax:941-764-8285
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)