MEDICARE: LYNN A CERSOSIMO BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	LBA00382	RI

General Provider Information

NPI Number	:	1912732868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN A CERSOSIMO BCBA

Provider Business Mailing Address
First Line	:	3 BARBER LN
Second Line	:
City	:	RICHMOND
State	:	RI
Zip	:	02832-3211
Country	:	US
Telephone Number	:	401-862-4670
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 BARBER LN
Second Line	:
City	:	RICHMOND
State	:	RI
Zip	:	02832-3211
Country	:	US
Telephone Number	:	401-862-4670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2024
Last Update Date	:	09/02/2024

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