Provider Demographics
NPI:1700767464
Name:WISEMAN, PAIGE ELIZABETH (BCBA)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:VIDALIA
Other - Middle Name:
Other - Last Name:WISEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:135 JENKINS ST # 105B207
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5175
Mailing Address - Country:US
Mailing Address - Phone:321-368-7551
Mailing Address - Fax:
Practice Address - Street 1:1717 E CARY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7024
Practice Address - Country:US
Practice Address - Phone:321-368-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst