Healthcare Provider Details

I. General information

NPI: 1235936238
Provider Name (Legal Business Name): CHASTITY RENEE CASANOVA BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 N POST RD
INDIANAPOLIS IN
46216-1000
US

IV. Provider business mailing address

6109 W PENROD RD
MUNCIE IN
47304-4624
US

V. Phone/Fax

Practice location:
  • Phone: 317-300-5725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17266
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: