Provider Demographics
NPI:1639331580
Name:CASTRO, GUSTAVO MIGUEL (MD COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:MIGUEL
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD COUNSELOR
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Mailing Address - Street 1:250 S 13TH ST
Mailing Address - Street 2:APT. 1 C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5615
Mailing Address - Country:US
Mailing Address - Phone:215-455-3768
Mailing Address - Fax:215-426-1086
Practice Address - Street 1:3263 N FRONT STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:216-426-1077
Practice Address - Fax:215-429-1086
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health