Provider Demographics
NPI:1174194302
Name:AUGUSTYNIAK, CASEY (BCBA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:AUGUSTYNIAK
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 1:320 E 1ST AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3786
Mailing Address - Country:US
Mailing Address - Phone:720-259-5500
Mailing Address - Fax:
Practice Address - Street 1:320 E 1ST AVE STE 101
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-3786
Practice Address - Country:US
Practice Address - Phone:720-259-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-51942103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst