Provider Demographics
NPI:1598499766
Name:GERARDO, KASEY (RBT)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:GERARDO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SEPAL ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-6676
Mailing Address - Country:US
Mailing Address - Phone:919-395-6195
Mailing Address - Fax:
Practice Address - Street 1:128 SEPAL ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-6676
Practice Address - Country:US
Practice Address - Phone:919-395-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician