Provider Demographics
NPI:1184977340
Name:BALESTRIERI, VINCENT LOUIS (BCBA)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:LOUIS
Last Name:BALESTRIERI
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2581 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2336
Mailing Address - Country:US
Mailing Address - Phone:732-598-8150
Mailing Address - Fax:
Practice Address - Street 1:1811 A ST
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2621
Practice Address - Country:US
Practice Address - Phone:732-598-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst