Provider Demographics
NPI:1508273947
Name:CASTRO, FERNANDO (MA)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4038
Mailing Address - Country:US
Mailing Address - Phone:321-842-2972
Mailing Address - Fax:407-834-5011
Practice Address - Street 1:455 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4038
Practice Address - Country:US
Practice Address - Phone:321-842-2972
Practice Address - Fax:407-834-5011
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12703101YM0800X
IL180.009205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional