Provider Demographics
NPI:1871041319
Name:CASTRO, ANGELIQUE MANUELA (MS)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:MANUELA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4956 W BRIGANTINE CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1800
Mailing Address - Country:US
Mailing Address - Phone:302-494-2736
Mailing Address - Fax:
Practice Address - Street 1:4956 W BRIGANTINE CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1800
Practice Address - Country:US
Practice Address - Phone:302-494-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health