Provider Demographics
NPI:1164183661
Name:CASTANEDA, MARIA ROSA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ROSA
Last Name:CASTANEDA
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 1:5317 NW 187TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-5309
Mailing Address - Country:US
Mailing Address - Phone:954-446-4110
Mailing Address - Fax:
Practice Address - Street 1:701 PROMENADE DRIVE
Practice Address - Street 2:STE 250
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026
Practice Address - Country:US
Practice Address - Phone:954-399-2637
Practice Address - Fax:954-272-7110
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-190664103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst