Provider Demographics
NPI:1225617772
Name:CASTRO, JORDAN (LMSW, CASAC-2)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:LMSW, CASAC-2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3034 GOMER ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-2724
Mailing Address - Country:US
Mailing Address - Phone:917-715-2841
Mailing Address - Fax:
Practice Address - Street 1:3034 GOMER ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-2724
Practice Address - Country:US
Practice Address - Phone:917-715-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30762101YA0400X
NY1120561041S0200X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool