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NPI Code Detail

MEDICARE: LISA ANN LAROSE M.ED, BCBA, LBA

MEDICARE: LISA ANN LAROSE M.ED, BCBA, LBA
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
1103K00000XBehavior Analyst2018015025MO

General Provider Information

NPI Number : 1275023814
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ANN LAROSE M.ED, BCBA, LBA
Provider Business Mailing Address
First Line : 5821 THOLOZAN AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63109-1437
Country : US
Telephone Number : 314-201-0152
Fax Number :
Provider Business Practice Location Address
First Line : 650 OFFICE PKWY
Second Line :
City : CREVE COEUR
State : MO
Zip : 63141-7103
Country : US
Telephone Number : 314-838-1465
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2018
Last Update Date : 05/17/2018

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