Provider Demographics
NPI:1902625486
Name:CASTILLA, ANNIE (BCBA)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:CASTILLA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WATER FRONT VW
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1217
Mailing Address - Country:US
Mailing Address - Phone:516-698-7149
Mailing Address - Fax:
Practice Address - Street 1:72 WEST ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6531
Practice Address - Country:US
Practice Address - Phone:203-200-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst