Provider Demographics
NPI:1083449557
Name:CASTEDO, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:CASTEDO
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 1:318 W JERSEY ST APT B1
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1886
Mailing Address - Country:US
Mailing Address - Phone:862-285-1876
Mailing Address - Fax:
Practice Address - Street 1:318 W JERSEY ST APT B1
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1886
Practice Address - Country:US
Practice Address - Phone:862-285-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101200000X, 103T00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist