Individual
CONNIE CASTRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1018 BROAD ST STE 6, BLOOMFIELD, NJ 07003-2884
(862) 930-5700
(973) 707-2283
Mailing address
1018 BROAD ST STE 6, BLOOMFIELD, NJ 07003-2884
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
37AC00558700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37AC00558700
LAC
NJ
Enumeration date
03/08/2021
Last updated
03/08/2021
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