Provider Demographics
NPI:1659079671
Name:CASTRO, NALTY M (RBT)
Entity Type:Individual
Prefix:
First Name:NALTY
Middle Name:M
Last Name:CASTRO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12319 SW 110TH S CANAL STREET RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4801
Mailing Address - Country:US
Mailing Address - Phone:786-277-8396
Mailing Address - Fax:
Practice Address - Street 1:7340 SW 48TH ST STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5520
Practice Address - Country:US
Practice Address - Phone:786-227-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-124716106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician