Individual provider · Type 1 NPI
Lissa Boileau
Psychiatric/Mental Health Nurse Practitioner · Ronkonkoma, NY
NPI number
1174840367
Active
Practice location
2 The Plz
Ronkonkoma, NY 11779-5849
Mailing address
2100 Nesconset Hwy # 1060
Stony Brook, NY 11790-3503
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 22609284 (NY) |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 406771 (NY) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1174840367
Lissa Boileau's National Provider Identifier is 1174840367, issued on Apr 27, 2010. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Ronkonkoma, NY. The record was last updated on Apr 20, 2026.