Provider Demographics
NPI:1487549408
Name:CASTRO, KEILA ENID (PSYD)
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:ENID
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 36 BOX 11601
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9565
Mailing Address - Country:US
Mailing Address - Phone:787-315-1990
Mailing Address - Fax:
Practice Address - Street 1:1666 CALLE PARANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3145
Practice Address - Country:US
Practice Address - Phone:939-264-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5909103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling