Provider Demographics
NPI:1033709803
Name:MCNEILL, LAURISSA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LAURISSA
Middle Name:
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LAURISSA
Other - Middle Name:
Other - Last Name:NIETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20432 SANTA ANA AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0275
Mailing Address - Country:US
Mailing Address - Phone:951-541-1614
Mailing Address - Fax:
Practice Address - Street 1:9844 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4381
Practice Address - Country:US
Practice Address - Phone:760-815-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA1-21-53142103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician