Provider Demographics
NPI:1114164092
Name:CASTILLO, ALEJANDRO LAZARO (MS)
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:LAZARO
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 NE 195TH ST
Mailing Address - Street 2:# 419
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3340
Mailing Address - Country:US
Mailing Address - Phone:305-308-2867
Mailing Address - Fax:
Practice Address - Street 1:671 NE 195TH ST
Practice Address - Street 2:# 419
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-3340
Practice Address - Country:US
Practice Address - Phone:786-344-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-010848-2015101YA0400X
FLMT2349106H00000X
FLMH8360101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty