Provider Demographics
NPI:1124310438
Name:CASSELL, CHARLES CHRISTIAN (MS, BCBA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHRISTIAN
Last Name:CASSELL
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:FL
Mailing Address - Zip Code:32949-0230
Mailing Address - Country:US
Mailing Address - Phone:321-676-6122
Mailing Address - Fax:321-676-6382
Practice Address - Street 1:7770 OAK GROVE CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7120
Practice Address - Country:US
Practice Address - Phone:561-642-9917
Practice Address - Fax:561-642-9917
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-02-0752103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst