Provider Demographics
NPI:1700829785
Name:GARRIDO-CASTILLO, PEDRO (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:GARRIDO-CASTILLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3234
Mailing Address - Country:US
Mailing Address - Phone:617-983-6013
Mailing Address - Fax:617-983-6069
Practice Address - Street 1:930 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3234
Practice Address - Country:US
Practice Address - Phone:617-983-6013
Practice Address - Fax:617-983-6069
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3864103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0515574Medicaid
MAR44270Medicare UPIN
MA0515574Medicaid