Healthcare Provider Details

I. General information

NPI: 1881138782
Provider Name (Legal Business Name): LAURENT PLAISIMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 CUMMINS HWY
ROSLINDALE MA
02131-3825
US

IV. Provider business mailing address

304 CUMMINS HWY
ROSLINDALE MA
02131-3825
US

V. Phone/Fax

Practice location:
  • Phone: 617-750-0184
  • Fax:
Mailing address:
  • Phone: 617-750-0184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12261309
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: