MEDICARE: DR. JEFFREY R. BRUSINI D.BH., ESQ.

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	103G00000X	Clinical Neuropsychologist	PS01761	RI
2	103TC2200X	Clinical Child & Adolescent Psychologist	PS01761	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11549500	OTHER		CAQH

General Provider Information

NPI Number	:	1801955547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY R. BRUSINI D.BH., ESQ.

Provider Business Mailing Address
First Line	:	NEUROBEHAVIORAL CONSULTANTS, LLC
Second Line	:	2893 POST RD
City	:	WARWICK
State	:	RI
Zip	:	02886
Country	:	US
Telephone Number	:	401-831-6277
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 NORTH RD A-23
Second Line	:
City	:	PEACE DALE
State	:	RI
Zip	:	02879
Country	:	US
Telephone Number	:	401-831-6277
Fax Number	:

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	03/31/2022

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