Provider Demographics
NPI:1801659628
Name:CASTILLO, DAMIAN NORBERTO
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:NORBERTO
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 TURNBERRY CIR APT 23
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-4223
Mailing Address - Country:US
Mailing Address - Phone:561-351-6415
Mailing Address - Fax:
Practice Address - Street 1:4165 TURNBERRY CIR APT 23
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-4223
Practice Address - Country:US
Practice Address - Phone:561-351-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-304388106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician