Provider Demographics
NPI:1093954133
Name:BRUMMETT, BRADLEY ROGER (PHD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ROGER
Last Name:BRUMMETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 E MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3036
Mailing Address - Country:US
Mailing Address - Phone:413-270-2003
Mailing Address - Fax:413-585-9902
Practice Address - Street 1:421 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053
Practice Address - Country:US
Practice Address - Phone:413-584-4040
Practice Address - Fax:413-582-3178
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22495103G00000X
MA9390103G00000X
NY025751103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist