Provider Demographics
NPI:1073044798
Name:BALATSKY, MARINA (BA)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:BALATSKY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 GALBRATH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-2802
Mailing Address - Country:US
Mailing Address - Phone:916-213-4245
Mailing Address - Fax:
Practice Address - Street 1:4100 GALBRATH DR
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-2802
Practice Address - Country:US
Practice Address - Phone:916-213-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician