Provider Demographics
NPI:1639460876
Name:CASTRO RAMOS, ENEIDA BELEN (MENTAL HEALTH)
Entity Type:Individual
Prefix:
First Name:ENEIDA
Middle Name:BELEN
Last Name:CASTRO RAMOS
Suffix:
Gender:F
Credentials:MENTAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 CURTIS BREATHWAITE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1269
Mailing Address - Country:US
Mailing Address - Phone:757-386-9334
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-386-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3202103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3202OtherMY LICENSE NUMBER IS THE IDENTIFICATION NUMBER.
PR0241Medicaid
FL3202OtherMY LICENSE NUMBER IS THE IDENTIFICATION NUMBER.