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NPI Code Detail

MEDICARE: VICTORIA MICHEL BOESEN MA, BCABA

MEDICARE: VICTORIA MICHEL BOESEN MA, BCABA
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
1106E00000XAssistant Behavior Analyst0-23-14540LA

General Provider Information

NPI Number : 1003597626
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA MICHEL BOESEN MA, BCABA
Provider Business Mailing Address
First Line : 14507 ESSEN TERRACE DR
Second Line :
City : GONZALES
State : LA
Zip : 70737-7164
Country : US
Telephone Number : 985-233-1074
Fax Number :
Provider Business Practice Location Address
First Line : 17520 OLD JEFFERSON HWY
Second Line :
City : PRAIRIEVILLE
State : LA
Zip : 70769-3903
Country : US
Telephone Number : 225-300-6710
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2023
Last Update Date : 07/27/2023

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