Provider Demographics
NPI:1477958080
Name:CASTELLON, LUIS ALEJANDRO JR (BS)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALEJANDRO
Last Name:CASTELLON
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 FRANK ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-3202
Mailing Address - Country:US
Mailing Address - Phone:203-543-3565
Mailing Address - Fax:
Practice Address - Street 1:121 FRANK ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-3202
Practice Address - Country:US
Practice Address - Phone:203-543-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health