Provider Demographics
NPI:1427402338
Name:BRIZUELA, MARIA SUSANA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:SUSANA
Last Name:BRIZUELA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14416 VICTORY BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6260
Mailing Address - Country:US
Mailing Address - Phone:818-997-2816
Mailing Address - Fax:818-997-2819
Practice Address - Street 1:14416 VICTORY BLVD STE 225
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6260
Practice Address - Country:US
Practice Address - Phone:818-997-2816
Practice Address - Fax:818-997-2819
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-17
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-21933103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst