MEDICARE: ASHLEY NICOLE BALIFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	LBA1057	MD

General Provider Information

NPI Number	:	1104482835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICOLE BALIFF

Provider Business Mailing Address
First Line	:	14088 BIG BRANCH DR
Second Line	:
City	:	DAYTON
State	:	MD
Zip	:	21036-1253
Country	:	US
Telephone Number	:	667-786-0431
Fax Number	:

Provider Business Practice Location Address
First Line	:	14088 BIG BRANCH DR
Second Line	:
City	:	DAYTON
State	:	MD
Zip	:	21036-1253
Country	:	US
Telephone Number	:	667-786-0431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2019
Last Update Date	:	07/19/2021

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Directions to “ ASHLEY NICOLE BALIFF ” Practice Location

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