Provider Demographics
NPI:1518580331
Name:GOYA, LISSA M (EDD, BCBA, LBA)
Entity type:Individual
Prefix:DR
First Name:LISSA
Middle Name:M
Last Name:GOYA
Suffix:
Gender:F
Credentials:EDD, BCBA, LBA
Other - Prefix:DR
Other - First Name:LISSA
Other - Middle Name:M
Other - Last Name:GOYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, BCBA/LBA
Mailing Address - Street 1:94-527 POLOAHILANI ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2488
Mailing Address - Country:US
Mailing Address - Phone:808-542-6168
Mailing Address - Fax:
Practice Address - Street 1:94-527 POLOAHILANI ST
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2488
Practice Address - Country:US
Practice Address - Phone:808-542-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI365103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst