Provider Demographics
NPI:1912704784
Name:BERGANTINO, CADEN WALLACE
Entity type:Individual
Prefix:
First Name:CADEN
Middle Name:WALLACE
Last Name:BERGANTINO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 BONE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34604-8218
Mailing Address - Country:US
Mailing Address - Phone:727-277-5911
Mailing Address - Fax:
Practice Address - Street 1:5145 BONE LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34604-8218
Practice Address - Country:US
Practice Address - Phone:727-277-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL189650106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician