Provider Demographics
NPI:1952186710
Name:NAKATO GRAVALLESE, IRENE JUDITH (RBT)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:JUDITH
Last Name:NAKATO GRAVALLESE
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 1:3660 N RANCHO DR STE 113
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3188
Mailing Address - Country:US
Mailing Address - Phone:702-209-3544
Mailing Address - Fax:
Practice Address - Street 1:3660 N RANCHO DR STE 113
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3188
Practice Address - Country:US
Practice Address - Phone:702-209-3544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT3669106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician