Provider Demographics
NPI:1598030520
Name:NGUYEN, CASANDRA (BCBA)
Entity Type:Individual
Prefix:
First Name:CASANDRA
Middle Name:
Last Name:NGUYEN
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 1:1526 BROOKHOLLOW DR
Mailing Address - Street 2:#70
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5421
Mailing Address - Country:US
Mailing Address - Phone:866-278-6264
Mailing Address - Fax:
Practice Address - Street 1:1526 BROOKHOLLOW DR
Practice Address - Street 2:#70
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5421
Practice Address - Country:US
Practice Address - Phone:866-278-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3442103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst