LISETTE BROUSSARD BCBA
NPI 1417512658
Behavior Analyst in San Diego, CA

Q: What is Lisette Broussard's NPI number?

The NPI number for Lisette Broussard is 1417512658. It was assigned to this individual provider in the NPPES registry on May 2, 2019.

Q: What is Lisette Broussard's specialty?

The primary specialty registered for this NPI is Behavior Analyst with taxonomy code 103K00000X.

Q: When was this NPI record last updated?

The NPPES record for Lisette Broussard was last updated on September 15, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 02, 2019

8885 RIO SAN DIEGO DR STE 340, SAN DIEGO, CA 92108(619) 795-9925 Get Directions Write a Review

NPPES record last updated: September 15, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 15, 2021, May 2, 2019 (2 updates tracked since 2019).

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About Lisette Broussard Bcba NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LISETTE BROUSSARD BCBA (NPI 1417512658) is an individual behavior analyst provider in San Diego, California, licensed in California (1-21-51914) and active in the NPI registry since May 2019.

NPPES Registry Identity

NPI1417512658

Entity TypeIndividualFemale

Primary Taxonomy103K00000X

Provider Legal NameLISETTE BROUSSARDCredential: BCBA

Location Address8885 RIO SAN DIEGO DR STE 340San Diego, CA 92108-1669

Mailing Address11650 Iberia Pl Ste 130San Diego, CA 92128-2431 · (858) 264-5858

Phone(619) 795-9925

Sole ProprietorNo

Enumeration DateMay 2, 2019

Last NPPES UpdateSeptember 15, 20212 updates tracked since enumeration

NPPES CertifiedSeptember 15, 2021

✔ NPI 1417512658 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyBehavior AnalystBehavioral Health & Social Service Providers

Taxonomy Code103K00000X

License✔ Licensed in CA · 1-21-51914

Definition

A behavior analyst is qualified by at least a master's degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans.

Also ListedBehavior TechnicianTaxonomy 106S00000X

8885 RIO SAN DIEGO DR STE 340, San Diego, CA 92108

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KELSEY GOODWIN GLOCKLER

Behavior Technician