Provider Demographics
NPI:1598104465
Name:BOISVERT, LISA (BCBA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BOISVERT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 18TH ST APT G7
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8056
Mailing Address - Country:US
Mailing Address - Phone:425-999-5010
Mailing Address - Fax:
Practice Address - Street 1:1905 18TH ST APT G7
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-8056
Practice Address - Country:US
Practice Address - Phone:425-999-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60759334103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst