Provider Demographics
NPI:1841570983
Name:CASTRO, ALICE (MA)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15545 DEVONSHIRE ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2638
Mailing Address - Country:US
Mailing Address - Phone:818-377-4484
Mailing Address - Fax:
Practice Address - Street 1:15545 DEVONSHIRE ST STE 208
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2638
Practice Address - Country:US
Practice Address - Phone:818-377-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-21
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17744106H00000X
NV4098-R106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist