Provider Demographics
NPI:1699433904
Name:CESARINI, LISA (BCBA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CESARINI
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 1:4388 W MAGRATH DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-0021
Mailing Address - Country:US
Mailing Address - Phone:916-397-3576
Mailing Address - Fax:
Practice Address - Street 1:4388 W MAGRATH DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-0021
Practice Address - Country:US
Practice Address - Phone:916-397-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst