Provider Demographics
NPI:1336694215
Name:CASTRO, KENYA L (MA IN SPECIAL EDUC)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:L
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MA IN SPECIAL EDUC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 N OXFORD WALK APT 2E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3138
Mailing Address - Country:US
Mailing Address - Phone:718-795-3504
Mailing Address - Fax:
Practice Address - Street 1:79 N OXFORD WALK APT 2E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3138
Practice Address - Country:US
Practice Address - Phone:718-795-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY783117252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency