Provider Demographics
NPI:1417448119
Name:CASTIN, SERGO
Entity Type:Individual
Prefix:
First Name:SERGO
Middle Name:
Last Name:CASTIN
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 1:7810 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6332
Mailing Address - Country:US
Mailing Address - Phone:631-336-6518
Mailing Address - Fax:
Practice Address - Street 1:7810 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6332
Practice Address - Country:US
Practice Address - Phone:631-336-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst