Individual
SAMANTHA BALLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 793-2695
(401) 444-4165
Mailing address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 793-2695
(401) 444-4165
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
LP06882
RI
Other
Enumeration date
01/17/2021
Last updated
05/17/2026
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