Provider Demographics
NPI:1225231095
Name:CASTRO, AMANDA (PSYD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 CHAPIN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4003
Mailing Address - Country:US
Mailing Address - Phone:415-340-1965
Mailing Address - Fax:
Practice Address - Street 1:1408 CHAPIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4003
Practice Address - Country:US
Practice Address - Phone:415-340-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical