Marisa Eileen Evanson, M.S., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

BCBA #1-10-6939 Issued in CA

Practice address

2127 W Orangewood Ave Ste B
Orange, CA 92868-1978

Phone

(714) 634-8500

NPI assigned

Jun 28, 2012

Last updated

Jun 28, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

Practice roles

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

• California Institute of Behavior Analysis

  dba LeafWing Center

  • Early Intervention Provider Agency
  • Orange, CA
  • NPI 1639316029
  NPD (past)
• Leafwing Center

  • Behavior Technician
  • Orange, CA
  • NPI 1306605779
  NPD (past)

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

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1770847253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 N STATE COLLEGE BLVD APT 1029",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928685703",
            "telephone_number": "626-975-0361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2127 W ORANGEWOOD AVE STE B",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928681978",
            "telephone_number": "714-634-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANSON",
        "first_name": "MARISA",
        "middle_name": "EILEEN",
        "credential": "M.S., BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-28",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "BCBA #1-10-6939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory R D Evans, MD
• Kimberly Joyce Evans, OT
• Lisa Marie Evans, NP
• Mark Gordon Evans, M.D.
• Shelon Evans
• Marc Eivind Evensen, MD
• Eveready Transportation
• Sierra Everett
• Evergreen Adult Home Care Inc.
• Evernorth Direct Health LLC

• Behavior Analyst in Orange, CA
• Providers in Orange, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; 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.