Provider Demographics
NPI:1336491240
Name:CASTRO, JENNY ELIZABETH (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ELIZABETH
Last Name:CASTRO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:ELIZABETH
Other - Last Name:MERCEDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6714 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-8128
Mailing Address - Country:US
Mailing Address - Phone:718-458-4243
Mailing Address - Fax:
Practice Address - Street 1:6714 41ST AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-8128
Practice Address - Country:US
Practice Address - Phone:718-458-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker