Provider Demographics
NPI:1154382620
Name:CASTRO-BETANCES, GERALDO (MD)
Entity type:Individual
Prefix:DR
First Name:GERALDO
Middle Name:
Last Name:CASTRO-BETANCES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 TILGHMAN ST
Mailing Address - Street 2:LVCMHC INC
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4354
Mailing Address - Country:US
Mailing Address - Phone:484-221-9135
Mailing Address - Fax:484-221-9130
Practice Address - Street 1:2152 NORTH FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-1705
Practice Address - Country:US
Practice Address - Phone:484-221-9135
Practice Address - Fax:484-221-9130
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16020208D00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health