Provider Demographics
NPI:1578289690
Name:BOITNOTT, CLARISSA CARMEN
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:CARMEN
Last Name:BOITNOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CLARISSA
Other - Middle Name:CARMEN
Other - Last Name:LIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5850 GRANITE PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25285 MADISON AVE STE 101
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8955
Practice Address - Country:US
Practice Address - Phone:951-397-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician