Provider Demographics
NPI:1548983133
Name:MIRANDA-CASTILLO, ALEXANDRA MARVEL (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:MARVEL
Last Name:MIRANDA-CASTILLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:MARVEL
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:212 BLOHM ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-6007
Mailing Address - Country:US
Mailing Address - Phone:203-600-4546
Mailing Address - Fax:
Practice Address - Street 1:2285 WHITNEY AVE STE 1
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3533
Practice Address - Country:US
Practice Address - Phone:203-200-0346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT27.003357106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3357OtherLICENSED MARITAL AND FAMILY THERAPIST