MEDICARE: BRIANNA ROY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1235681446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA ROY

Provider Business Mailing Address
First Line	:	4485 SAINT ROCH AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4485 SAINT ROCH AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-4921
Country	:	US
Telephone Number	:	504-782-6555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	11/04/2016

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Directions to “ BRIANNA ROY ” Practice Location

Language	Start Address	Practice Location

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