Provider Demographics
NPI:1407333800
Name:THE PSYCHOLOGY OFFICE OF DR. CONNIE JASMINE CASTRO PLLC
Entity Type:Organization
Organization Name:THE PSYCHOLOGY OFFICE OF DR. CONNIE JASMINE CASTRO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:JASMINE
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-991-1615
Mailing Address - Street 1:5392 62ND ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1233
Mailing Address - Country:US
Mailing Address - Phone:917-991-1615
Mailing Address - Fax:
Practice Address - Street 1:5392 62ND ST
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378
Practice Address - Country:US
Practice Address - Phone:917-991-1615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022577103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty