Provider Demographics
NPI:1083392609
Name:CASTRO-VEGA, AMARILYS (MSW)
Entity Type:Individual
Prefix:
First Name:AMARILYS
Middle Name:
Last Name:CASTRO-VEGA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 CHESTER CIR STE 113
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2270
Mailing Address - Country:US
Mailing Address - Phone:904-660-2103
Mailing Address - Fax:904-660-2103
Practice Address - Street 1:6015 CHESTER CIR STE 113
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2270
Practice Address - Country:US
Practice Address - Phone:904-660-2103
Practice Address - Fax:904-660-2103
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health