Provider Demographics
NPI:1215524608
Name:CASTILLO, KATHRYN SEGURA
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SEGURA
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 1:73 ADAMS ST APT 5
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5600
Mailing Address - Country:US
Mailing Address - Phone:978-401-6808
Mailing Address - Fax:
Practice Address - Street 1:73 ADAMS ST APT 5
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5600
Practice Address - Country:US
Practice Address - Phone:978-401-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician