1669899035 NPI number — MAGDALENA CASIMIRO M.ED., BCBA, LBA

Table of content: MAGDALENA CASIMIRO M.ED., BCBA, LBA (NPI 1669899035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669899035 NPI number — MAGDALENA CASIMIRO M.ED., BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASIMIRO
Provider First Name:
MAGDALENA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., BCBA, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERNANDEZ
Provider Other First Name:
MAGDALENA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669899035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 859
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98577-0859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-915-6868
Provider Business Mailing Address Fax Number:
360-547-6470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 BARNES BLVD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUMWATER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98512-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-915-6868
Provider Business Practice Location Address Fax Number:
360-547-6470
Provider Enumeration Date:
03/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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