Provider Demographics
NPI:1922145150
Name:CASTILLO, ELISA MARIA (MA)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:MARIA
Last Name:CASTILLO
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 1:15 DULCINEA LN
Mailing Address - Street 2:URB. PALMA REAL
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-9730
Mailing Address - Country:US
Mailing Address - Phone:787-594-3898
Mailing Address - Fax:787-823-7954
Practice Address - Street 1:125 CALLE PABLO CASALS
Practice Address - Street 2:SUITE1
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3945
Practice Address - Country:US
Practice Address - Phone:787-594-3898
Practice Address - Fax:787-823-7954
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1668103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist