Provider Demographics
NPI:1720769003
Name:CASILLAS, DAMARA ELIZABETH
Entity Type:Individual
Prefix:
First Name:DAMARA
Middle Name:ELIZABETH
Last Name:CASILLAS
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 1:34 JEROME AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2463
Mailing Address - Country:US
Mailing Address - Phone:860-375-5749
Mailing Address - Fax:
Practice Address - Street 1:44 GREEN ST APT 1F
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2777
Practice Address - Country:US
Practice Address - Phone:860-984-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6561104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker