Provider Demographics
NPI:1912492133
Name:CASTOR, MARY CATHERINE (AUD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:CASTOR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:URLACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:53-59 PUBLIC SQ STE 202
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2674
Mailing Address - Country:US
Mailing Address - Phone:315-786-3225
Mailing Address - Fax:
Practice Address - Street 1:53-59 PUBLIC SQUARE
Practice Address - Street 2:SUITE 202
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-786-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002807231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist