Provider Demographics
NPI:1992286769
Name:NILSSEN, AASHILD RENEE (RBT)
Entity type:Individual
Prefix:
First Name:AASHILD RENEE
Middle Name:
Last Name:NILSSEN
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 1:90 STATE STREET
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207
Mailing Address - Country:US
Mailing Address - Phone:631-385-7780
Mailing Address - Fax:631-385-7795
Practice Address - Street 1:90 STATE STREET
Practice Address - Street 2:SUITE 700
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:631-385-7795
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2019-07-13
Deactivation Date:2019-06-25
Deactivation Code:
Reactivation Date:2019-07-13
Provider Licenses
StateLicense IDTaxonomies
UTRBT-18-63359106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty