Provider Demographics
NPI:1174279376
Name:CASTILLO, BETZABE
Entity Type:Individual
Prefix:
First Name:BETZABE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 164TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1118
Mailing Address - Country:US
Mailing Address - Phone:718-380-3000
Mailing Address - Fax:
Practice Address - Street 1:8115 164TH ST FL 3
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1118
Practice Address - Country:US
Practice Address - Phone:718-380-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst