Provider Demographics
NPI:1063158814
Name:RAULERSON, RUBY (RBT)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:RAULERSON
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 1:2701 MICHIGAN AVE STE J
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1214
Mailing Address - Country:US
Mailing Address - Phone:321-355-3904
Mailing Address - Fax:407-225-6429
Practice Address - Street 1:2701 MICHIGAN AVE STE J
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1214
Practice Address - Country:US
Practice Address - Phone:321-355-3904
Practice Address - Fax:407-225-6429
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-22-214207OtherRBT