Provider Demographics
NPI:1548651649
Name:CASTILLO, MAGALY (MS)
Entity type:Individual
Prefix:MS
First Name:MAGALY
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CALLEJON BAEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4406
Mailing Address - Country:US
Mailing Address - Phone:787-513-0688
Mailing Address - Fax:
Practice Address - Street 1:57 CALLEJON BAEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4406
Practice Address - Country:US
Practice Address - Phone:787-513-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist