Provider Demographics
NPI:1952873606
Name:CASTILLO, SOFIA ISABEL
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:ISABEL
Last Name:CASTILLO
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 1:31 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3333
Mailing Address - Country:US
Mailing Address - Phone:347-706-9149
Mailing Address - Fax:
Practice Address - Street 1:31 CHERRY ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3333
Practice Address - Country:US
Practice Address - Phone:347-706-9149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1049391104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWUC87030819OtherEMPIRE BLUE CROSS BLUE SHIELD