Provider Demographics
NPI:1265267140
Name:CASTRO, MARILYN NICOLLE
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:NICOLLE
Last Name:CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 THURBERS AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4721
Mailing Address - Country:US
Mailing Address - Phone:401-383-5051
Mailing Address - Fax:
Practice Address - Street 1:134 THURBERS AVE STE 212
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4721
Practice Address - Country:US
Practice Address - Phone:401-383-5051
Practice Address - Fax:401-432-7082
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor