Provider Demographics
NPI:1770818676
Name:CASTILLO, ADELA ELVIRA (PSYD)
Entity Type:Individual
Prefix:MS
First Name:ADELA
Middle Name:ELVIRA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10-24 49TH AVENUE
Mailing Address - Street 2:LONG ISLAND CITY, BIRCH FAMILY SERVICES, WESTERN QUEENS
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101
Mailing Address - Country:US
Mailing Address - Phone:718-786-1104
Mailing Address - Fax:718-391-0040
Practice Address - Street 1:10-24 49TH AVENUE
Practice Address - Street 2:LONG ISLAND CITY, BIRCH FAMILY SERVICES, WESTERN QUEENS
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-786-1104
Practice Address - Fax:718-391-0040
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639679951103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist