Provider Demographics
NPI:1689727166
Name:CASTILLO, IVETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND COLINAS DE BAYAMON
Mailing Address - Street 2:250 CARR.831 APDO. 1005
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4818
Mailing Address - Country:US
Mailing Address - Phone:787-995-2224
Mailing Address - Fax:
Practice Address - Street 1:576 AVE. CESAR GONZALEZ
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-250-7280
Practice Address - Fax:787-250-7285
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1328103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist