Provider Demographics
NPI:1902415409
Name:PREVENAS, CARISSA LYNNE (BCBA)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:LYNNE
Last Name:PREVENAS
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 1:450 1ST ST SW APT 404
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5745
Mailing Address - Country:US
Mailing Address - Phone:319-721-1060
Mailing Address - Fax:
Practice Address - Street 1:700 BELL DR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-7406
Practice Address - Country:US
Practice Address - Phone:319-294-9577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst