Provider Demographics
NPI:1831473065
Name:CASTRO, JUAN A (BCBA)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:CASTRO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 HACKENSACK STREET
Mailing Address - Street 2:D
Mailing Address - City:WOOD-RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075
Mailing Address - Country:US
Mailing Address - Phone:323-472-3989
Mailing Address - Fax:
Practice Address - Street 1:358 HACKENSACK STREET
Practice Address - Street 2:D
Practice Address - City:WOOD-RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075
Practice Address - Country:US
Practice Address - Phone:323-472-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-09-6274103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst