Active NPI
Lisette Broussard, BCBA
- Behavior Analyst
- San Diego, CA
National Provider Identifier
1417512658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-21-51914
- Practice address
- 501 W Broadway
Ste 800
San Diego, CA 92101 - Phone
- (855) 832-6727
- NPI assigned
- May 2, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-21-51914 | CA | Primary |
Addresses
Primary practice location
501 W Broadway
Ste 800
San Diego, CA 92101
Mailing address
7108 S Kanner Hwy
Stuart, FL 34997
Phone (855) 832-6727
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772323200000",
"number": "1417512658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7108 S KANNER HWY",
"city": "STUART",
"state": "FL",
"postal_code": "34997",
"telephone_number": "855-832-6727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 W BROADWAY",
"address_2": "STE 800",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92101",
"telephone_number": "855-832-6727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "LISETTE",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-02",
"last_updated": "2026-03-01",
"certification_date": "2026-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-21-51914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.