Provider Demographics
NPI:1376147918
Name:BALLESTEROS, MARIA (RBT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BALLESTEROS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 VASSAR ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3224
Mailing Address - Country:US
Mailing Address - Phone:775-448-6533
Mailing Address - Fax:775-787-2751
Practice Address - Street 1:2440 VASSAR ST STE 3
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3224
Practice Address - Country:US
Practice Address - Phone:775-448-6533
Practice Address - Fax:775-787-2751
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT1438106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-20-141887OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD
NVRBT1438OtherSTATE OF NEVADA BOARD OF APPLIED BEHAVIOR ANALYSIS