Provider Demographics
NPI:1417442310
Name:PSYCHOLOGY CASTRO LEBRON PSC
Entity Type:Organization
Organization Name:PSYCHOLOGY CASTRO LEBRON PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVELISSE L
Authorized Official - Middle Name:CASTRO
Authorized Official - Last Name:LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:939-262-8213
Mailing Address - Street 1:A15 CALLE BRAZIL
Mailing Address - Street 2:URB EL JARDIN
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:939-262-8213
Mailing Address - Fax:
Practice Address - Street 1:168 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4782
Practice Address - Country:US
Practice Address - Phone:939-262-8213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty