Provider Demographics
NPI:1356088173
Name:CASTANINO-DALY, PAUL JAMES
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:CASTANINO-DALY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 DRUID HILL AVE E
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-5432
Mailing Address - Country:US
Mailing Address - Phone:617-686-4210
Mailing Address - Fax:
Practice Address - Street 1:37 DRUID HILL AVE E
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-5432
Practice Address - Country:US
Practice Address - Phone:617-686-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA755393Medicaid
MA929191201Medicaid