Provider Demographics
NPI:1760920169
Name:CASTILLO DE MOLINA, BELEN (MA, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:BELEN
Middle Name:
Last Name:CASTILLO DE MOLINA
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 KENT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2702
Mailing Address - Country:US
Mailing Address - Phone:718-622-9285
Mailing Address - Fax:718-398-4155
Practice Address - Street 1:850 KENT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2702
Practice Address - Country:US
Practice Address - Phone:718-622-9285
Practice Address - Fax:718-398-4155
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026389-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist