Provider Demographics
NPI:1164008439
Name:CASTILLO ANDRE, DARY MARTIN
Entity Type:Individual
Prefix:
First Name:DARY
Middle Name:MARTIN
Last Name:CASTILLO ANDRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAVIS SQ
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2904
Mailing Address - Country:US
Mailing Address - Phone:617-803-9934
Mailing Address - Fax:
Practice Address - Street 1:1 DAVIS SQ
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2904
Practice Address - Country:US
Practice Address - Phone:617-803-9934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator