Provider Demographics
NPI:1447775382
Name:BRICENO, MARIANNY DE LOS ANGELES
Entity Type:Individual
Prefix:
First Name:MARIANNY
Middle Name:DE LOS ANGELES
Last Name:BRICENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2894 W 72ND TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5389
Mailing Address - Country:US
Mailing Address - Phone:305-924-3434
Mailing Address - Fax:
Practice Address - Street 1:2894 W 72ND TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5389
Practice Address - Country:US
Practice Address - Phone:305-924-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician