Provider Demographics
NPI:1346927845
Name:CASTILLO CONCEPCION, MILAY
Entity Type:Individual
Prefix:
First Name:MILAY
Middle Name:
Last Name:CASTILLO CONCEPCION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 NW 197TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-2263
Mailing Address - Country:US
Mailing Address - Phone:786-585-2129
Mailing Address - Fax:
Practice Address - Street 1:3620 NW 197TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-2263
Practice Address - Country:US
Practice Address - Phone:786-585-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician