Provider Demographics
NPI:1952655987
Name:BYRNE, LISA MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BYRNE
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 1:1901 ROYAL OAKS DR
Mailing Address - Street 2:STE. 201
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-3868
Mailing Address - Country:US
Mailing Address - Phone:916-923-1789
Mailing Address - Fax:916-923-1169
Practice Address - Street 1:1901 ROYAL OAKS DR
Practice Address - Street 2:STE. 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3868
Practice Address - Country:US
Practice Address - Phone:916-923-1789
Practice Address - Fax:916-923-1169
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-12653103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-12-12653OtherBCBA CERTIFICATION