Provider Demographics
NPI:1154964948
Name:DANIEL DECASTRO, MFT LLC
Entity type:Organization
Organization Name:DANIEL DECASTRO, MFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DECASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-794-4714
Mailing Address - Street 1:32 GARELLA RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1016
Mailing Address - Country:US
Mailing Address - Phone:203-994-0475
Mailing Address - Fax:
Practice Address - Street 1:57 NORTH ST STE 115
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5626
Practice Address - Country:US
Practice Address - Phone:203-794-4714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008057105Medicaid