Provider Demographics
NPI:1689457301
Name:BALABANIS, KAYLA ROSE (RBT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ROSE
Last Name:BALABANIS
Suffix:
Gender:F
Credentials:RBT
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5665 COLLEGE AVE STE 240D
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1647
Mailing Address - Country:US
Mailing Address - Phone:510-418-2231
Mailing Address - Fax:
Practice Address - Street 1:600 PENNSYLVANIA AVE SE UNIT 15707
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-7529
Practice Address - Country:US
Practice Address - Phone:443-690-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDRBT-23-289171106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician