Provider Demographics
NPI:1659949188
Name:CASTRO RODRIGUEZ, MANUEL DE JESUS (LCSW, MS)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:DE JESUS
Last Name:CASTRO RODRIGUEZ
Suffix:
Gender:M
Credentials:LCSW, MS
Other - Prefix:
Other - First Name:MANNY
Other - Middle Name:D
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, MS
Mailing Address - Street 1:17 E 102ND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1468 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6508
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089852-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical