Provider Demographics
NPI:1275029605
Name:CASTILLO BERNAL, KEELY M (BCBA)
Entity Type:Individual
Prefix:MS
First Name:KEELY
Middle Name:M
Last Name:CASTILLO BERNAL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
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Mailing Address - Street 1:970 BEARDSLEY DR
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2406
Mailing Address - Country:US
Mailing Address - Phone:323-243-7755
Mailing Address - Fax:
Practice Address - Street 1:3336 BRADSHAW RD STE 140
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2697
Practice Address - Country:US
Practice Address - Phone:916-245-4133
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-39375103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst