Lissa Boileau
Nurse Practitioner, Psych/Mental Health in Ronkonkoma, NY. Individual provider (NPI-1).
NPI number1174840367
StatusActive
Last updated in NPPESApr 20, 2026
Details
- NPI
- 1174840367
- Entity type
- Individual (NPI-1)
- Name
- Lissa Boileau
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 27, 2010
- Certification date
- Apr 20, 2026
- Last updated
- Apr 20, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 406771 | NY | Yes |
| 163W00000X | Registered Nurse | 22609284 | NY |
Practice location
2 The PlzRonkonkoma, NY 11779-5849
Phone 631-676-2765
Mailing address
2100 Nesconset Hwy # 1060Stony Brook, NY 11790-3503
Phone 646-789-5877 · Fax 888-253-5730
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