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General NPI Number Information
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NPI Number | 1053700864
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Entity Type | Individual
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Provider Name | MINDY JEANNE CASSANO M.S., BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 07/03/2017
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Provider Practice Location Address
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Address Line | 1737 VETERANS MEMORIAL HWY
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City | ISLANDIA
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State | NY
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Zip | 11749-1529
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Country | US
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Telephone | 631-872-6435
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Fax |
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Provider Business Mailing Address
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Address Line | 27 RUTH PL
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City | NORTH BABYLON
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State | NY
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Zip | 11703-4912
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 71000611
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License Number State | NY
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