Basic Information
| Provider Information | |||||||||
| NPI: | 1942353404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTRO | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, LCMHC, MLADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2032 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033022032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032267505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 130 PEMBROKE RD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033015792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032267505 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 0128 | NH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 716 | NH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.