Provider Demographics
NPI:1447833496
Name:ANICETO, CASSEY
Entity type:Individual
Prefix:
First Name:CASSEY
Middle Name:
Last Name:ANICETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5284 ADOLFO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-6790
Mailing Address - Country:US
Mailing Address - Phone:805-289-0120
Mailing Address - Fax:805-289-0130
Practice Address - Street 1:5284 ADOLFO RD STE 100
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-6790
Practice Address - Country:US
Practice Address - Phone:805-289-0120
Practice Address - Fax:805-289-0130
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56CCOtherASPIRA