Provider Demographics
NPI:1538601026
Name:CASTILLO, MARLENE MISHELL (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:MISHELL
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4138 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4345
Mailing Address - Country:US
Mailing Address - Phone:646-731-0085
Mailing Address - Fax:
Practice Address - Street 1:4138 BARNES AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4345
Practice Address - Country:US
Practice Address - Phone:646-731-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NY002407-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician