Lissa Boileau

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

406771 Issued in NY

Practice address

2 The PLZ
Ronkonkoma, NY 11779-5849

Phone

(631) 676-2765

NPI assigned

Apr 27, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrative Wellness Nurse Practitioner in Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • New York, NY
  • NPI 1336745058
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776643200000",
    "number": "1174840367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 NESCONSET HWY # 1060",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117903503",
            "telephone_number": "646-789-5877",
            "fax_number": "888-253-5730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 THE PLZ",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117795849",
            "telephone_number": "631-676-2765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOILEAU",
        "first_name": "LISSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-27",
        "last_updated": "2026-04-20",
        "certification_date": "2026-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "22609284",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "406771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlyn Bilz, MHC-LP
• Elizabeth Binstock, LCSW
• Pat Bivona
• Amanda Ashley Bodendorf, MSW
• Bohemia Medical, PC
• Frank William Bonnici, CEP
• Stephen John Boose, LMSW
• Ted Borkstrom, CASAC
• Tara Botter, RN
• Bottizer Radiological PC

• Psychiatric/Mental Health Nurse Practitioner in Ronkonkoma, NY
• Providers in Ronkonkoma, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.