Mia Boissevain

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

650 State St
Watertown, NY 13601-2839

Phone

(518) 651-2302

Fax

(315) 291-6601

NPI assigned

Jul 3, 2024

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Citizen Advocates, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Malone, NY
  • NPI 1780619064
  NPD

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

{
    "created_epoch": "1719964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1740026368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21502 REDWOOD LN APT C",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136016259",
            "telephone_number": "207-423-1968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 STATE ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012839",
            "telephone_number": "518-651-2302",
            "fax_number": "315-291-6601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21502 Redwood Ln Apt C",
            "address_purpose": "LOCATION",
            "city": "Watertown",
            "state": "NY",
            "postal_code": "136016259",
            "country_code": "US",
            "telephone_number": "207-423-1968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOISSEVAIN",
        "first_name": "MIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-03",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Rose Birchenough, D.O.
• Christopher Philip Black, M.D.
• Julee Blackwell
• Joyce Blosser
• Laura Ellen Boggs, DO
• Diane Margery Bolden, LPN
• Tonya Anne Boliver, RN
• Bhupinder S Bolla, M.D.
• Boltons Pharmacy Inc
• Boltons Pharmacy Inc

• Case Manager/Care Coordinator in Watertown, NY
• Providers in Watertown, NY by specialty
• Case Manager/Care Coordinator in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.