Provider Demographics
NPI:1649676339
Name:DEAN, LISA (BCBA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DEAN
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 1:42181 PATUXENT DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-3787
Mailing Address - Country:US
Mailing Address - Phone:301-318-8264
Mailing Address - Fax:
Practice Address - Street 1:42181 PATUXENT DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-3787
Practice Address - Country:US
Practice Address - Phone:301-318-8264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst