Provider Demographics
NPI:1912554767
Name:CARVALHO, ROCKY RONALD JACK JR (RBT-19-109008)
Entity Type:Individual
Prefix:
First Name:ROCKY
Middle Name:RONALD JACK
Last Name:CARVALHO
Suffix:JR
Gender:M
Credentials:RBT-19-109008
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 CONCORD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1220 CONCORD AVE STE 101
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4906
Practice Address - Country:US
Practice Address - Phone:916-308-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician