Provider Demographics
NPI:1467126862
Name:CASTLE, GWENDOLYN MARIE
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:MARIE
Last Name:CASTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:MARIE
Other - Last Name:BANTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1689 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4022
Mailing Address - Country:US
Mailing Address - Phone:845-279-2995
Mailing Address - Fax:845-278-4089
Practice Address - Street 1:1689 ROUTE 22
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4022
Practice Address - Country:US
Practice Address - Phone:845-279-2995
Practice Address - Fax:845-278-4089
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health