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General NPI Number Information
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NPI Number | 1063899599
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Entity Type | Individual
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Provider Name | KARISSA PREUDHOMME
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Gender | Female
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 735 TIVOLI CIR APT 201
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-8112
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Country | US
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Telephone | 336-978-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 58 NORTH AVE APT 102
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City | NATICK
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State | MA
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Zip | 01760-3569
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Country | US
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Telephone | 336-978-4443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 15-11178
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-43664
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License Number State | MA
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