Provider Demographics
NPI:1245564392
Name:CASTRO, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:7060 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5014
Mailing Address - Country:US
Mailing Address - Phone:954-871-2507
Mailing Address - Fax:
Practice Address - Street 1:7060 SW 20TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-5014
Practice Address - Country:US
Practice Address - Phone:954-871-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLSW135371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor