Provider Demographics
NPI:1558709725
Name:CASTRO, EKATERINA S (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:EKATERINA
Middle Name:S
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CRAIGIE ST
Mailing Address - Street 2:APT 2
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2414
Mailing Address - Country:US
Mailing Address - Phone:617-947-9810
Mailing Address - Fax:
Practice Address - Street 1:65 CRAIGIE ST
Practice Address - Street 2:APT 2
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2414
Practice Address - Country:US
Practice Address - Phone:617-947-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1161791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical