Provider Demographics
NPI:1417312786
Name:GUASTELLA, CASIANNE
Entity Type:Individual
Prefix:
First Name:CASIANNE
Middle Name:
Last Name:GUASTELLA
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 1:2739 WOODBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4868
Mailing Address - Country:US
Mailing Address - Phone:732-685-2456
Mailing Address - Fax:
Practice Address - Street 1:95 FARLEY AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1004
Practice Address - Country:US
Practice Address - Phone:732-685-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NJR6129 11400 61855103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician