Provider Demographics
NPI:1407443120
Name:CASTILLO CUEVAS, DERAY
Entity Type:Individual
Prefix:
First Name:DERAY
Middle Name:
Last Name:CASTILLO CUEVAS
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 1:18 WADSWORTH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7420
Mailing Address - Country:US
Mailing Address - Phone:617-935-2683
Mailing Address - Fax:
Practice Address - Street 1:18 WADSWORTH ST APT 1
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-7420
Practice Address - Country:US
Practice Address - Phone:617-935-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician