Provider Demographics
NPI:1356236665
Name:CASTILLO, KATHLEEN Y
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:Y
Last Name:CASTILLO
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 1:480 SAINT NICHOLAS AVE APT 11C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2712
Mailing Address - Country:US
Mailing Address - Phone:929-569-7033
Mailing Address - Fax:
Practice Address - Street 1:480 SAINT NICHOLAS AVE APT 11C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2712
Practice Address - Country:US
Practice Address - Phone:929-569-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25795942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer