Individual
LISSA BOILEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2 THE PLZ, RONKONKOMA, NY 11779-5849
(631) 676-2765
Mailing address
2100 NESCONSET HWY # 1060, STONY BROOK, NY 11790-3503
(646) 789-5877
(888) 253-5730
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
22609284
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
406771
NY
Other
Enumeration date
04/27/2010
Last updated
04/20/2026
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