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NPI Code Detail

MEDICARE: RYAN MATTHEW BALESTRERY LMFT

MEDICARE: RYAN MATTHEW BALESTRERY LMFT
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
1106H00000XMarriage & Family Therapist124557CA

General Provider Information

NPI Number : 1619498110
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN MATTHEW BALESTRERY LMFT
Provider Business Mailing Address
First Line : 2495 W MARCH LN
Second Line :
City : STOCKTON
State : CA
Zip : 95207-8251
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 629 OAKLAND AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94611-4567
Country : US
Telephone Number : 209-834-7685
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2017
Last Update Date : 01/21/2026

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Directions to “ RYAN MATTHEW BALESTRERY LMFT” Practice Location

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