Provider Demographics
NPI:1457896904
Name:GALVEZ, BERNADETTE NICOLE (RBT, BBA)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:NICOLE
Last Name:GALVEZ
Suffix:
Gender:F
Credentials:RBT, BBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 1/2 GARLAND CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-8044
Mailing Address - Country:US
Mailing Address - Phone:970-361-5381
Mailing Address - Fax:
Practice Address - Street 1:304 INVERNESS WAY S STE 125
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-5820
Practice Address - Country:US
Practice Address - Phone:844-427-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO309216855106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician