Provider Demographics
NPI:1316351729
Name:CABOT, LISSANDRA (BCBA)
Entity type:Individual
Prefix:
First Name:LISSANDRA
Middle Name:
Last Name:CABOT
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 1:5205 VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-7907
Mailing Address - Country:US
Mailing Address - Phone:786-374-7857
Mailing Address - Fax:
Practice Address - Street 1:5205 VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-7907
Practice Address - Country:US
Practice Address - Phone:954-532-0337
Practice Address - Fax:954-208-0680
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-47057103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst