Provider Demographics
NPI:1649611716
Name:CASILLAS, ISIS B
Entity type:Individual
Prefix:MISS
First Name:ISIS
Middle Name:B
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8980 W FLAGLER ST
Mailing Address - Street 2:APT. 108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3963
Mailing Address - Country:US
Mailing Address - Phone:786-280-8505
Mailing Address - Fax:
Practice Address - Street 1:9415 SW 72ND ST STE 131
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5492
Practice Address - Country:US
Practice Address - Phone:305-662-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral