Provider Demographics
NPI:1942576822
Name:BRUNELLI, SUSAN ANNE (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:BRUNELLI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-6120
Mailing Address - Country:US
Mailing Address - Phone:845-598-4621
Mailing Address - Fax:
Practice Address - Street 1:341 77TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3109
Practice Address - Country:US
Practice Address - Phone:718-745-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011050-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist