Provider Demographics
NPI:1598225518
Name:LEBSOCK, CARISSA (BCBA)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:LEBSOCK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:VANASTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:2073 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9106
Mailing Address - Country:US
Mailing Address - Phone:920-351-3027
Mailing Address - Fax:920-351-3043
Practice Address - Street 1:2073 LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9106
Practice Address - Country:US
Practice Address - Phone:920-351-3027
Practice Address - Fax:920-351-3043
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI301140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst