Provider Demographics
NPI:1922298892
Name:CASTRO, SUZANNE KRISTY (PSYD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KRISTY
Last Name:CASTRO
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 1:6465 REFLECTIONS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2355
Mailing Address - Country:US
Mailing Address - Phone:614-792-1108
Mailing Address - Fax:614-792-0018
Practice Address - Street 1:6465 REFLECTIONS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2355
Practice Address - Country:US
Practice Address - Phone:614-792-1108
Practice Address - Fax:614-792-0018
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist