Provider Demographics
NPI:1538905492
Name:MUSCAGLIONE, BRISA EVELYN (RBT)
Entity type:Individual
Prefix:
First Name:BRISA
Middle Name:EVELYN
Last Name:MUSCAGLIONE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 JAMES SLAGLE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-5022
Mailing Address - Country:US
Mailing Address - Phone:702-600-0344
Mailing Address - Fax:
Practice Address - Street 1:7251 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8351
Practice Address - Country:US
Practice Address - Phone:702-387-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1417610585Medicaid