Provider Demographics
NPI:1598354862
Name:CASTLE, BONNIE LYNN
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:CASTLE
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 1:8425 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931-4414
Mailing Address - Country:US
Mailing Address - Phone:707-606-8902
Mailing Address - Fax:
Practice Address - Street 1:8425 LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-4414
Practice Address - Country:US
Practice Address - Phone:707-606-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst