Provider Demographics
NPI:1669859757
Name:BROUSSEAU, LIANNA (PHD, BCBA-D, LBA-CT)
Entity type:Individual
Prefix:DR
First Name:LIANNA
Middle Name:
Last Name:BROUSSEAU
Suffix:
Gender:F
Credentials:PHD, BCBA-D, LBA-CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PEACH ORCHARD HL
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1541
Mailing Address - Country:US
Mailing Address - Phone:203-530-1881
Mailing Address - Fax:
Practice Address - Street 1:18 PEACH ORCHARD HL
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1541
Practice Address - Country:US
Practice Address - Phone:203-530-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst