Provider Demographics
NPI:1174147078
Name:CASTROGIOVANNI, EMMA (BCBA)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:CASTROGIOVANNI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 SPRING ST UNIT 4211
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9378
Mailing Address - Country:US
Mailing Address - Phone:630-200-0226
Mailing Address - Fax:
Practice Address - Street 1:575 DONOFRIO DR STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2832
Practice Address - Country:US
Practice Address - Phone:630-200-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI365-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst