Provider Demographics
NPI:1154547800
Name:CASTAGNO, REUBEN MIKHAEL (MENTAL HEALTH (LMHC))
Entity type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:MIKHAEL
Last Name:CASTAGNO
Suffix:
Gender:M
Credentials:MENTAL HEALTH (LMHC)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 QUEENS BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3629
Mailing Address - Country:US
Mailing Address - Phone:718-753-1766
Mailing Address - Fax:
Practice Address - Street 1:10420 QUEENS BLVD
Practice Address - Street 2:SUITE 1K
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3629
Practice Address - Country:US
Practice Address - Phone:718-753-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003008-1101YM0800X
NY1339260103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool