Provider Demographics
NPI:1215462262
Name:BALLINGER, RAYMOND
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 FOUR MILE COVE PKWY APT 1120
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2437
Mailing Address - Country:US
Mailing Address - Phone:407-389-9966
Mailing Address - Fax:407-960-3009
Practice Address - Street 1:1773 FOUR MILE COVE PKWY APT 1120
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2437
Practice Address - Country:US
Practice Address - Phone:407-389-9966
Practice Address - Fax:407-960-3009
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst