Healthcare Provider Details

I. General information

NPI: 1750205100
Provider Name (Legal Business Name): KARISSA MCLEAN MS LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 ROUTE 6 AND 209
MILFORD PA
18337-7615
US

IV. Provider business mailing address

510 ROUTE 6 AND 209
MILFORD PA
18337-7615
US

V. Phone/Fax

Practice location:
  • Phone: 570-296-3992
  • Fax:
Mailing address:
  • Phone: 570-296-3992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008330
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: