Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003185331 |
---|---|
Provider Name | Jessica Castronovo |
First Address | Palatine, IL 60067-4791 |
Second Address | Palatine, IL 60067-4791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2011 |
Last Update Date | 15/12/2011 |