Provider Demographics
NPI:1871935213
Name:BRIZUELA, KAELA L
Entity type:Individual
Prefix:
First Name:KAELA
Middle Name:L
Last Name:BRIZUELA
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 1:15A RICE TER FL 2
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3858
Mailing Address - Country:US
Mailing Address - Phone:508-930-7657
Mailing Address - Fax:
Practice Address - Street 1:15A RICE TER FL 2
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3858
Practice Address - Country:US
Practice Address - Phone:508-930-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-20-42646103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty