Provider Demographics
NPI:1952792277
Name:CASTILLA-BROOKS, CHIARA (MS)
Entity type:Individual
Prefix:
First Name:CHIARA
Middle Name:
Last Name:CASTILLA-BROOKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CHIARA
Other - Middle Name:CORINNE
Other - Last Name:CASTILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2734
Mailing Address - Country:US
Mailing Address - Phone:347-495-8855
Mailing Address - Fax:
Practice Address - Street 1:55 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2734
Practice Address - Country:US
Practice Address - Phone:347-495-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101Y00000X, 103K00000X, 172V00000X, 174H00000X, 225400000X
NYCASAC-32643 TRAINEE101YA0400X
NYP03748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)