Provider Demographics
NPI:1417635673
Name:WILSON, MARIA (RBT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WILSON
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 1:2 ADAMS ST APT 1406
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5727
Mailing Address - Country:US
Mailing Address - Phone:720-755-2207
Mailing Address - Fax:
Practice Address - Street 1:215 N. MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:CO
Practice Address - Zip Code:81226
Practice Address - Country:US
Practice Address - Phone:720-400-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-282123106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-23-282123OtherBACB