Provider Demographics
NPI:1760938666
Name:CARRIVEAU, ALISSA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:CARRIVEAU
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:MAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7501 W DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2833
Mailing Address - Country:US
Mailing Address - Phone:414-750-4845
Mailing Address - Fax:
Practice Address - Street 1:7501 W DAKOTA ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-2833
Practice Address - Country:US
Practice Address - Phone:414-750-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst