MEDICARE: BRIANNA MARCELL KUZNETSOV

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	106S00000X	Behavior Technician		FL
2	103K00000X	Behavior Analyst	1-21-51759	AL

General Provider Information

NPI Number	:	1467084954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA MARCELL KUZNETSOV

Provider Business Mailing Address
First Line	:	1026 COVE PALISADES DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-6618
Country	:	US
Telephone Number	:	210-305-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 COVE PALISADES DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-6618
Country	:	US
Telephone Number	:	210-305-0203
Fax Number	:

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

Provider Enumeration Date	:	02/12/2020
Last Update Date	:	08/18/2025

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