Provider Demographics
NPI:1972135879
Name:GASPARO, THOMAS (BCBA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:GASPARO
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 1:2224 75TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-1400
Mailing Address - Country:US
Mailing Address - Phone:262-914-8440
Mailing Address - Fax:
Practice Address - Street 1:7533 22ND AVE STE 106
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5711
Practice Address - Country:US
Practice Address - Phone:262-496-8735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI334-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst