Healthcare Provider Details

I. General information

NPI: 1083449557
Provider Name (Legal Business Name): BIANCA CASTEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W JERSEY ST APT B1
ELIZABETH NJ
07202-1886
US

IV. Provider business mailing address

318 W JERSEY ST APT B1
ELIZABETH NJ
07202-1886
US

V. Phone/Fax

Practice location:
  • Phone: 862-285-1876
  • Fax:
Mailing address:
  • Phone: 862-285-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: