Basic Information
| Provider Information | |||||||||
| NPI: | 1497880785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTRO | ||||||||
| FirstName: | IRIS | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 OVERLOOK DR | ||||||||
| Address2: | |||||||||
| City: | WEST SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010894525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133359908 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8803 VISTANA CENTRE DR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328216354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133016019 | ||||||||
| FaxNumber: | 4133632857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 113914 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SW18892 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.