Provider Demographics
NPI:1336962265
Name:CASTRO, KATIUSHKA Y
Entity type:Individual
Prefix:
First Name:KATIUSHKA
Middle Name:Y
Last Name:CASTRO
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:HC 1 BOX 9165
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-9763
Mailing Address - Country:US
Mailing Address - Phone:787-470-4076
Mailing Address - Fax:
Practice Address - Street 1:490 PAGE BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3026
Practice Address - Country:US
Practice Address - Phone:413-349-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker