MEDICARE: MIJANOU BRAZZINI

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	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst
3	103K00000X	Behavior Analyst	MH15946	FL

General Provider Information

NPI Number	:	1700374261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIJANOU BRAZZINI

Provider Business Mailing Address
First Line	:	2201 BRICKELL AVE APT 67
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33129-2134
Country	:	US
Telephone Number	:	305-877-5335
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 BRICKELL AVE APT 67
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33129-2134
Country	:	US
Telephone Number	:	305-877-5335
Fax Number	:

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

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	06/08/2023

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