Provider Demographics
NPI:1679312151
Name:BAILLIE, HUNTER BERNARD (RBT)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:BERNARD
Last Name:BAILLIE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:WEST HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060
Mailing Address - Country:US
Mailing Address - Phone:609-686-4640
Mailing Address - Fax:
Practice Address - Street 1:6 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:732-858-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-23-257199106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician