Provider Demographics
NPI:1942992730
Name:CASTRO, CLARISSA ARIEL (LMSW)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:ARIEL
Last Name:CASTRO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GRUMMAN RD. W
Mailing Address - Street 2:STE. 1000
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5028
Mailing Address - Country:US
Mailing Address - Phone:516-465-4700
Mailing Address - Fax:516-465-4740
Practice Address - Street 1:15 GRUMMAN RD. W
Practice Address - Street 2:STE. 1000
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5028
Practice Address - Country:US
Practice Address - Phone:516-465-4700
Practice Address - Fax:516-465-4740
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110135104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker